Keywords:
Vascular, Veins / Vena cava, Genital / Reproductive system male, Fluoroscopy, CT-Angiography, Embolisation, Sclerosis, Varices
Authors:
R. Gandini, D. Konda, M. Chiocchi, E. Pampana, D. Morosetti, A. Chiaravalloti, G. Loreni, G. Simonetti; Rome/IT
DOI:
10.1594/ecr2013/C-0800
Purpose
Pelvic Congestion Syndrome (PCS),
also known aspelvic pain syndrome and pelvic venous incompetence,is characterized by non-cyclic chronic pelvic with a duration of more than 6 months associated with the presence of ovarian or pelvic varices.
This condition usually affectsmultiparous young women of childbearing age and can be potentially debilitating.
The most common symptoms are pelvic pain of variable intensity and duration that can be associated todysmenorrhea,dyspareunia,
post-coital pain and bladder irritability .
Pain can extend to leg and can be worsened by walking or postural changes (1).
The majority of patients also present lower limb varices.
Although several theories have been put forth to explain the etiology of PCS it remains unclear and it is likely being multifactorial .
Since several other pelvic disorders may present with overlapping symptoms (fibroids,
adenomyosis,
endometriosis,
pelvic inflammatory disease,
ovarian and fallopian tube diseases, pelvic tumors,
cystitis,
inflammatory bowel diseases and adhesions),diagnosis of PCS may be very challenging.
Computed Tomography (CT) and Magnetic Resonance (MR) imaging can reveal only large pelvic varices while laparoscopy can fail to demonstrate the presence of pelvic varices in over 80% of the cases .
Transvaginal color-Doppler US can be used to confirm the presence of ovarian and/or pelvic varices larger than 5 mm in diameter and the presence of venous reflux .
Conventional surgical options,
such ashysterectomy with or without bilateral salpingo-oophorectomy and laparoscopic techniques,
are burdened by high rates of recurrence rates and aesthetic damage and usually require 2-5 days of hospitaliasation (1).
Recently various endovascular procedures using metal coils and sclerosing agents have been described with low recurrence rates (2).
Moreover,
endovascular procedures may be performed in a day-hospital setting,
thus not requiring hospitalization with reduction of costs and patient discomfort.
The treatment of high-flow pelvic varices with large collateral vessels communicating with the hypogastric or ovarian veins may be particularly arduous and require the placement of several coils with the potential risk of coil migration (3).
We present our experience in 12 patients with PCS presenting high-flow pelvic varices treated by balloon-occlude retrogradetransvenous foam sclerotherapy (B-ORTFS)using a 3% sodium-tetradecyl-sulphate (STS) – air foam.