Diagnosis and treatment of pelvic congestion syndrome in women with interventional radiology methods

Abstract

Aim. Evaluation of the results of venography and efficacy of gonadal veins embolization in female patients with pelvic congestive syndrome and concomittant genital pathology. 
 Methods. The study included 61 patients with pelvic varicosities diagnosed on the basis of ultrasound and Doppler studies of the veins with obligatory use of Valsalva test. The average age of the patients was 34.11±0.98 years. Patients were divided into groups according to the presence or absence of concomitant genital pathology: group A - 16 patients with pelvic varicose veins without concomitant genital pathology; group B - 20 patients with pelvic varicose veins and endometriosis; group C - 25 patients with pelvic varicose veins and other genital pathology. All patients underwent selective pelvic vein embolization by the combined method with the use of coils and sclerosants. The variants of anatomical structure of venous system in patients from three groups were clarified according to the results of venography. Efficacy of the method was assessed by the change in pelvic pain intensity according to Visual Analogue Scale before and after embolization. 
 Results. Bilateral pelvic varicose veins in all groups was the most prevalent variant diagnosed in venography. In groups A and C 87.5 and 84% of patients, respectively, noted improvement. In group B 35% of patients reported improvement, while 65% maintained pain after embolization. However, even while maintaining pain, decrease of its intensity was reported by 35% of patients, but in 6 (30%) of cases it required surgical organ-resecting treatment. 
 Conclusion. Venograghy in pelvic congestive syndrome in women is characterized by stagnation of venous blood in the venous system of pelvis with the reflux and valvular incompetence; endovascular method confirmed its high efficiency for relieving pelvic pain syndrome; we had no complications during the study.