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Pelvic congestion syndrome.

Janette D Durham1, Lindsay Machan2

  • 1Department of Radiology, University of Colorado Denver, Aurora, Colorado.

Seminars in Interventional Radiology
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Pelvic congestion syndrome, a cause of chronic pelvic pain in women, is effectively treated with embolization. This endovascular therapy significantly improves symptoms compared to surgical options.

Keywords:
female varicocelenutcracker syndromepelvic congestion syndromepelvic pain syndromepelvic vascular congestionpelvic vein incompetencevulvar varices

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Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Gynecology

Background:

  • Pelvic congestion syndrome (PCS) is an underdiagnosed cause of chronic pelvic pain in young, premenopausal women.
  • PCS is characterized by pelvic venous insufficiency and varicosities, leading to symptoms like lower back pain, dyspareunia, and discomfort exacerbated by standing.

Purpose of the Study:

  • To evaluate the effectiveness of endovascular therapy, specifically embolization, for treating pelvic congestion syndrome.
  • To compare the outcomes of embolization with surgical therapy in patients refractory to hormonal treatment.

Main Methods:

  • Diagnosis involves clinical history, imaging (transvaginal ultrasound, venography), and confirmation of ovarian vein reflux.
  • Treatment focuses on endovascular embolization to eliminate ovarian vein reflux and/or sclerosis of pelvic varicosities.

Main Results:

  • Endovascular therapy, particularly embolization, has demonstrated significant long-term efficacy in improving PCS symptoms.
  • Embolization is more effective than surgical therapy for patients who have not responded to hormonal management.
  • Symptom reduction rates range from 70% to 90% following treatment.

Conclusions:

  • Embolization is a validated and effective treatment for pelvic congestion syndrome.
  • Endovascular approaches offer superior symptom improvement compared to surgical interventions for PCS.
  • PCS should be considered in the differential diagnosis of chronic pelvic pain in women.