Pelvic venous congestion syndrome: female venous congestive syndromes and endovascular treatment options

Abstract

Pelvic venous congestion syndrome (PVCS) is a common, but underdiagnosed, cause of chronic pelvic pain (CPP) in women.PVCS occurs usually, but not exclusively, in multiparous women. It is characterized by chronic pelvic pain of more than six months duration with no evidence of inflammatory disease.The patients present to general practitioners, gynaecologists, vascular specialists, pain specialists, gastroenterologists and psychiatrists. Pain of variable intensity occurs at any time but is worse in the pre-menstrual period, and is exacerbated by walking, standing, and fatigue. Post coital ache, dysmenorrhea, dyspareunia, bladder irritability and rectal discomfort are also common. Under-diagnosis of this condition can lead to anxiety and depression.A multidisciplinary approach in the investigation and management of these women is vital.Non-invasive imaging (US, CT, MRI) are essential in the diagnosis and exclusion of other conditions that cause CPP as well in the definitive diagnosis of PVCS. Trans-catheter venography remains the gold standard modality for the definitive diagnosis and is undertaken as an immediate precursor to ovarian vein embolization (OVE). Conservative, medical and surgical management strategies have been reported but have been superseded by OVE, which has a reported technical success rates of 96–100%, low complication rates and long-term symptomatic relief in between 70–90% of cases.The condition, described in this paper as PVCS, is referred to by a wide variety of other terms in the literature, a cause of confusion.There is a significant body of literature describing the syndrome and the excellent outcomes following OVE however the lack of prospective, multicentre randomized controlled trials for both investigation and management of PVCS is a significant barrier to the complete acceptance of both the existence, investigation and management of the condition.

Interventional Therapy of Pelvic Venous Disorders (PeVD)

“…A hemodynamic evaluation of reflux can be performed using the Valsalva maneuver [10,11]. Three sonographic criteria are important for confirming the suspected diagnosis of a pelvic venous disorder: Dilated tortuous pelvic veins with a diameter of more than 6 mm, slow blood flow (≤ 3 cm/s), and a dilated arcuate vein in the myometrium that is connected to the pelvic varices [12,13].…”

“…The administration of NSAIDs can partially alleviate postinterventional symptoms due to the induced phlebitis [12]. More serious complications like deep vein thrombosis, pulmonary embolisms, and coil migration are rare [3].…”

“…Embolization has a very high technical success rate of 97-100 % [3,17]. The clinical result is also described as very good with success rates of 70-100 % [18], and the published recurrence rates are approximately 10-40 % [3,12,19]. However, long-term clinical success can only be measured on a limited basis or cannot be measured due to the current lack of standardization of data regarding treatment results in published studies.…”

“…Eine hämodynamische Beurteilung des Refluxes kann unter Valsalva-Manöver erfolgen [10,11]. Drei sonografische Unterscheidungskriterien sind wichtig, um die Verdachtsdiagnose eines Beckenvenensyndroms zu stellen: erweiterte gewundene Beckenvenen mit einem Durchmesser von mehr als 6 mm, langsamer Blutfluss (≤ 3 cm/s) und eine erweiterte Bogenvene im Myometrium, die mit den Beckenvarizen in Verbindung steht [12,13].…”

“…Die Verabreichung von NSAIDs kann postinterventionelle Beschwerden, die durch die induzierte Phlebitis entstehen, teilweise lindern [12]. Schwerwiegendere Komplikationen wie tiefe Venenthrombosen, Lungenembolien oder Coilmigration sind selten [3].…”