Pelvic Congestion Syndrome (Pelvic Venous Incompetence): Impact of Ovarian and Internal Iliac Vein Embolotherapy on Menstrual Cycle and Chronic Pelvic Pain

Venbrux, Anthony C.; Chang, Andrew; Montague, Brian J.; Hebert, Jillyn B.; Arepally, Aravind; Rowe, Peter C.; Barron, Diana F.; Lambert, Denis; Robinson, J. C.

doi:10.1016/s1051-0443(07)61935-6

Cited by 200 publications

(129 citation statements)

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“…Eleven were included from the review of the diagnostic accuracy of non-invasive technique 23,[36][37][38][39][40][41][42][43][44][45] and 21 were included from the review of embolisation; 15,31,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] one study was included in both reviews. 65 A summary of the inclusion criteria from the selected studies is given in Table 1.…”

Section: Studies Reviewedmentioning

confidence: 99%

“…A further 12 studies described their populations as women with chronic pelvic or lower abdominal pain with no further elaboration of the nature of the symptoms required for inclusion 15,31,38,[40][41][42][56][57][58][59]63,64 and only three specifying 6 months as the minimum duration of symptoms. 40,44,50 Six studies did describe particular pain symptoms; 38,39,[50][51][52]65 one study from 1999 selected for the diagnostic review and the remainder describing the effectiveness of embolisation, all subsequent to 2007.…”

Section: Pain Symptomsmentioning

confidence: 99%

See 1 more Smart Citation

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

Champaneria

Shah

Moss³

et al. 2016

Health Technol Assess

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BackgroundPelvic congestion syndrome (PCS) is described as chronic pelvic pain (CPP) arising from dilated and refluxing pelvic veins, although the causal relationship between pelvic vein incompetence (PVI) and CPP is not established. Non-invasive screening methods such as Doppler ultrasound and magnetic resonance venography are used before confirmation by venography. Percutaneous embolisation has become the principal treatment for PCS, with high success rates often cited.ObjectivesOur proposal aimed to systematically and critically review the definitions and diagnostic criteria of PCS, the association between PVI and CPP, the accuracy of various non-invasive imaging techniques and the effectiveness of embolisation for PVI; and to identify factors associated with successful outcome. We also wished to survey clinicians and patients to assess awareness and management of PCS and gauge the enthusiasm for further research.Data sourcesA comprehensive search strategy encompassing various terms for pelvic congestion, pain, imaging techniques and embolisation was deployed in 17 bibliographic databases, including MEDLINE, EMBASE and Web of Science. There was no restriction on study design.MethodsMethodological quality was assessed using appropriate tools. Online surveys were sent to clinicians and patients. The quality and heterogeneity generally precluded meta-analysis and so results were tabulated and described narratively.ResultsWe identified six association studies, 10 studies involving ultrasound, two studies involving magnetic resonance venography, 21 case series and one poor-quality randomised trial of embolisation. There were no consistent diagnostic criteria for PCS. We found that the associations between CPP and PVI were generally fairly similar, with three of five studies with sufficient data showing statistically significant associations (odds ratios of between 31 and 117). The prevalence of PVI ranged widely, although the majority of women with PVI had CPP. Transvaginal ultrasound with Doppler and magnetic resonance venography are both useful screening methods, although the data on accuracy are limited. Early substantial relief from pain symptoms was observed in approximately 75% of women undergoing embolisation, a figure which generally increased over time and was sustained. Reintervention rates were generally low. Transient pain was a common occurrence following foam embolisation, while there was a < 2% risk of coil migration. Confidence in the embolisation technique is reasonably high, although there is a desire to strengthen the evidence base. Even among women with CPP, fewer than half had any knowledge about PCS.ConclusionsThe data supporting the diagnosis and treatment of PCS are limited and of variable methodological quality. There is some evidence to tentatively support a causative association, but it cannot be categorically stated that PVI is the cause of CPP in women with no other pathology, as the six most pertinent drew on clinically disparate populations and defined PVI inconsistently. Embolisation appears to provide symptomatic relief in the majority of women and is safe. However, the majority of included studies of embolism were relatively small case series and only the randomised controlled trial was considered at risk of potential biases. There is scope and demand for considerable further research. The question of the association of PVI and CPP requires a well-designed and well-powered case–control study, which will also provide data to derive a diagnostic standard. An adequately powered randomised trial is essential to provide evidence on the effectiveness of embolisation, but this faces methodological challenges.Study registrationThis study is registered as PROSPERO CRD42012002237 and CRD42012002238.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Studies Reviewedmentioning

confidence: 99%

Section: Pain Symptomsmentioning

confidence: 99%

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

Champaneria

Shah

Moss³

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…18 These authors injected 5% sodium morrhuate mixed with gelfoam into the pelvic veins from the ovarian vein before its occlusion with stainless steel or platinum coils. In a staged fashion, at a separate procedure, appropriate branches of the internal iliac vein were then embolized in the majority of patients by injecting sclerosant through an occlusion balloon.…”

Section: Treatmentmentioning

confidence: 99%

Pelvic Congestion Syndrome

Machan

2002

Journal of Vascular and Interventional Radiology

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“…It is one of the most common gynaecological complaints, estimated to affect about one-third of women in their lifetime. 1 In one study, the laparoscopic findings of women with chronic pelvic pain were endometriosis (31%), adhesions (23%), chronic pelvic inflammatory disease (PID) (7%), ovarian cyst (4%), myomas (<1%), pelvic varicosities (<1%) and others (4%). In about 36% of women, no laparoscopic cause of pelvic pain can be found.…”

Section: Introductionmentioning

confidence: 99%