Endovascular intervention for pelvic congestion syndrome is justified for chronic pelvic pain relief and patient satisfaction.

Abstract

Pelvic congestion syndrome (PCS) is difficult to diagnose, poorly understood, and often confused with other causes of chronic pelvic pain. Thus, gonadal vein reflux, its relation to lower extremity venous insufficiency (LEVI), and treatment remains controversial to physicians and payors. We present our experience with endovascular PCS treatment and hypothesize that properly selected patients can realize significant improvement. A retrospective study of patients treated for PCS at our institution from 2008 to 2012 was performed. Diagnosis was made clinically by the presence of pelvic pain, dyspareunia, and/or perineal varicosities. Clinical parameters, procedural details, and follow-up were reviewed. A questionnaire including a visual analog scale was sent to patients. Diagnosis was made in 15 women (mean age, 36years; mean parity, two). All had pelvic pain, 6 had dyspareunia, 14 had perineal varicosities, and 10 had concomitant LEVI. Fourteen had gonadal vein reflux (mean diameter, 7.4mm) and pelvic varicosities at angiography and had coiling (n= 12) and/or Amplatzer plug (St. Jude Medical, Inc, St. Paul, Minn) (n= 4). One patient had stenting ofastenotic left common iliac vein. All patients with concomitant LEVI had successful appropriate treatment. Eightpatients completed the questionnaire at a mean follow-up of 4years. The mean pelvic pain score went from 9.375 to 1.875post-procedure (P< .0001; Student t-test). Mean dyspareunia score went from 8.875 to 1.5 (P< .0001). Mean perineal varicosity pain score went from 9.285 to 1.285 (P< .0001). Two patients had recurrence with a mean pelvic pain score of 4.5 at a mean 21months. On a five-point Likert scale, all patients were satisfied (one) or extremely satisfied (seven) with treatment. Endovascular PCS treatment offers excellent pelvic pain relief and patient satisfaction. Women with pelvic pain, dyspareunia, or perineal varicosities with gonadal vein reflux and pelvic varicosities or iliac vein stenosis should not be denied treatment. A significant number may have concomitant LEVI and should be screened accordingly.