gms | German Medical Science

Background: Pelvic congestion syndrome (PCS) is a form of varicose disease, which is increasingly seen as the main cause of chronic pelvic pain in women which has a variety of clinical manifestations. Patients with PCS present with unexplained chronic pelvic pain that has been present for over 6 months. There are many causes for of the development of chronic pelvic pain, but the main place is occupied by pelvic congestion syndrome.

The aim of the study was to analyze the efficacy of the embolization of ovarian veins combined with sclerotherapy in patients with pelvic congestion syndrome.

Methods: We analyzed 10 patients with pelvic congestion syndrome, who underwent endovascular treatment. The average age was 45±9 years. BMI was 20,0 ± 3,1 points. Visual Analogue Scale (VAS) was 5,8±1,16 points. The pain syndrome had the following manifestations: abdominal pain in 60%, lumbar pain in 18%, pain in the left upper quadrant in 40%, pain in the left flank in 25%, pelvic pain was observed in 80% of patients and usually worsened after physical activity. Abdominal and transvaginal US was performed for all patients. The abdominal US shows the diameter ratios 4,5 ± 1,7 mm, PV ratios – 4,6 ± 3,6 cm. During transvaginal US we analyzed the diameters of paraovarian veins from the right one: 6,4 ± 1,0 mm and from the left one 8,0 ± 1,6 mm, and the diameter of the left (9,2 ± 1,7 mm) and right (5,9±1,7 mm) ovarian veins. CT angiography was performed in all cases, Nutcracker phenomenon was in 9 patients, May-Thurner syndrome was in 2 patients. The diameter of the left ovarian vein was 8,6±1,8 and 6,3±2,16 of the right ovarian vein.

Results: Endovascular ovarian vein embolization was performed for in all patients. In all cases we use right transfemoral access to the common femoral vein. After placing the 6F introducer, the catheter was placed into the left renal vein and diagnostic phlebography was performed. Then an embolization coil was placed in the lower third (Tornado type in 6 cases, Nestor type in 4 cases). After installing the coil, sclerosant foam was injected: 3% - 2 ml solution of Ethoxysclerol. Re-embolization was required in one case after an injection of sclerosant. Follow-up after 3 and 6 months. VAS was 1,2±1,1 points after 6 months.

Conclusion: A variety of unexplained chronic pain is associated with pelvic venous insufficiency, pelvic varicosis and the collateral blood flow. The use of a diagnostic algorithm will allow us to exclude intrinsic disease and plan an appropriate treatment strategy in a patient with PCS. Sclerotherapy reduces the necessity of using an additional embolization coils.