Pelvic Congestion Syndrome treated by ovarian vein embolization

Pelvic congestion syndrome (PCS) is one of the pelvic venous syndromes that is frequently misdiagnosed. It is a common cause of chronic pelvic pain in women of reproductive age. Pain that is intermittent or constant lasting for 3-6 months, present in the pelvic or abdominal region, occurring throughout the menstrual cycle, and without any association with pregnancy is chronic pelvic pain. Nearly 10%-20% of the gynecologic consultations are due to chronic pelvic pain complaints, and only 40% of them are referred for evaluation by a specialist.

Etiology
Pelvic venous insufficiency is due to the incompetency of the internal iliac vein, the ovarian vein, or both. It is often the underlying cause of pelvic congestion syndrome. Nearly 10% of women suffer from ovarian varices. Of this 10%, about 60% have pelvic congestion syndrome.

The congestion of the pelvic veins can be due to hormones, insufficiency of the valve, and venous obstruction. The release of pain-inducing substances due to increased dilatation of the veins along with stasis is a likely cause of the pain in PCS.

Diagnosis
The presence of characteristic pelvic venous changes on imaging supports the diagnosis.

For patients with PCS, in whom an intervention is being planned, require evaluation for pelvic venous reflux with ultrasound, retrograde internal iliac or ovarian venography, computed tomography (CT), or magnetic resonance (MR) imaging.

1. Ultrasound
2. Computed Tomography (CT scan)
3. Magnetic Resonance (MRI scan)
4. Venography
The gold standard for diagnosing pelvic congestion of the vasculature is ovarian and iliac catheter venography. Ovarian veins are catheterized by approaching via percutaneous jugular and femoral pathways. The distension of the venous channels is better assessed when a venogram is done during Valsalva. Venographic diagnostic findings of PCS that can be seen include incompetent pelvic veins (with diameter more than 5-10 mm), and congestion of flow in venous channels of ovarian, pelvic, vulvovaginal, and thigh veins. Venous reflux in ovarian veins can also be noted. same time you can treat the patient also
5. Laparoscopy

Pelvic vein or ovarian vein embolization (PVE or OVE) is a minimally invasive procedure that treats pelvic congestion syndrome (PCS) by reducing blood flow in the pelvis:

Procedure
A catheter is inserted into the groin and guided to the ovarian veins using X-ray imaging. A sclerosing agent, such as a special liquid or chemicals that cause inflammation, is injected into the veins. Small metal coils or plugs are also placed to block blood flow.

Benefits
Embolization is less invasive than open surgery, so there are fewer complications and a shorter hospital stay. It also results in less blood loss and no surgical incision.
Recovery

Patients can usually return to normal activities within a day or two. They should avoid strenuous exercise, take it easy at home, and drink plenty of fluids. Some patients may experience pelvic and back pain for a couple of days after the procedure.

Success rate
PVE has a reported success rate of 85% or higher. About 75% of patients report improved symptoms after the procedure. Multiple sessions may be required if multiple veins need to be treated.