Pelvic Congestion Syndrome: A Review of Current Diagnostic and Minimally Invasive Treatment Modalities

Abstract

Chronic pelvic pain is a debilitating medical condition with a host of potential causes. Although often overlooked, pelvic congestion syndrome (PCS) is a well-established cause of chronic pelvic pain due to abnormal ovarian and pelvic varices. The diagnosis is established with modern non-invasive cross-sectional imaging, preferably contrast enhanced magnetic resonance imaging. Although medical and open surgical therapies exist, transcatheter percutaneous embolotherapy has been shown to be a safe, effective and durable therapy for the treatment of PCS. Further prospective randomized studies are needed to refine optimal technique and assess long-term patient outcomes.

Venous angioplasty and stenting improve pelvic congestion syndrome caused by venous outflow obstruction

“…4,5 PCS due to other venous obstructions rarely is referenced in the medical literature. [6][7][8][9][10][11] Blättler and Blättler 12 reported in 1999 a series of 12 patients treated with stents for post-thrombotic iliac vein obstruction associated with venous claudication or neurogenic claudication. Neglen and Raju 13 subsequently reported a large series of patients treated with stenting for thrombotic and nonthrombotic iliac vein obstruction primarily for LE symptoms.…”

How do we define the term idiopathic?

“…This may include scarring and fibrosis [24] Adhesions Filmy avascular, dense and or vascular and cohesive bands between tissues and organs [25] Ovarian cysts Lower abdominal pain due to painful ovarian cysts (including functional, endometrioma and dermoid cysts) [22] Adenomyosis Lower abdominal or pelvic pain secondary to the presence of endometrial glands and stroma within the myometrium [22] Fibroids Benign tumours that develop in the uterus and pelvic cramping pain and dysmenorrhea [26] Other structural causes e.g. pelvic congestion Pelvic congestion syndrome is CPP due to abnormal ovarian and pelvic varices [27] Nongynaecological Psychological/psychosexual Depression, sleep disorders, sexual and physical abuse may be a consequence or cause of CPP [17 & ]…”

“…The differential diagnosis list is shown in Table 2 [17 & , [19][20][21][22][23][24][25][26][27][28]. One-to-one in depth interviews were undertaken with four practising gynaecologists from across the United Kingdom.…”

“…Along with all the available information from the literature search and qualitative interviews, each panel member proposed a definition. All possible definitions were discussed until a final consensus definition could be reached which was tested in relation to the related research project in order to capture the correct group of patients [27]. The working definition agreed for idiopathic CPP was: 'CPP with an uncertain or unknown structural cause i.e.…”

Síndrome da Congestão Venosa Pélvica e resultados do tratamento endovascular: série de casos

“…It is conducted via the same catheterization used for diagnostic venography and, performed in this manner, the treatment has proved to be safe and effective for control of the condition, with low rates of relapse and complications. 10 This article was approved by the local institutional Ethics Committee. The objective is to report an initial series of six cases of patients diagnosed with PCS who were treated using the endovascular technique at the Clínica Coris Medicina Avançada, in the city of Florianópolis, SC, Brazil, from 2011 to 2013, analyzing the results of clinical and imaging examinations conducted before treatment, intraoperatively and during the short-term postoperative period.…”