Treatment Of Pelvic Congestion Syndrome Research Articles

The role of vasoactive neuropeptides in the genesis of venous pelvic pain: A review.

Mechanisms of the development of pain in chronic venous diseases, including pelvic congestion syndrome, are not studied in detail so far. The existing hypotheses of the occurrence of venous pelvic pain do not allow to answer the question why some patients have no pain syndrome, while others have very pronounced pain despite the same morphofunctional changes in the pelvic veins. This review presents current hypotheses of the venous pelvic pain development, data on some vasoactive neuropeptides (endothelin, calcitonin gene-related peptide, and substance P), their role in the modulation of vascular tone and sensation of pain, and possible association between neurogenic inflammation and venous pelvic pain, as well as provides rationale for studying the activity of these neurotransmitters in the treatment of pelvic congestion syndrome and pelvic pain.

Who Makes the Diagnosis and Implement Treatment for Pelvic Congestion Syndrome

Who Makes the Diagnosis and Implement Treatment for Pelvic Congestion Syndrome

Endovenous treatment of pelvic congestion syndrome

Introduction: Dilated and refluxing incompetent pelvic veins are a cause of chronic pain.

Neurobiological aspects of venous pelvic pain

Mechanisms of the development of pain in chronic venous diseases (CVD), including pelvic congestion syndrome (PCS), are understudied. The existing hypotheses of the occurrence of venous pelvic pain (VVP) do not allow to answer the question why some patients have no pain syndrome while others have very pronounced pain despite the same morphofunctional changes in the pelvic veins. This review presents current hypotheses of the VPP development, data on some vasoactive neuropeptides (endothelin, calcitonin gene-related peptide, and substance P), their role in the modulation of vascular tone and sensation of pain, possible association between neurogenic inflammation and VPP and provides a rationale for studying the activity of these neurotransmitters in the treatment of PCS and pelvic pain.

Maximizing Patient Satisfaction and Positive Outcomes in the Diagnosis and Treatment of Pelvic Congestion Syndrome in the Outpatient Surgical Setting: A Cohort of 102 Patients

Maximizing Patient Satisfaction and Positive Outcomes in the Diagnosis and Treatment of Pelvic Congestion Syndrome in the Outpatient Surgical Setting: A Cohort of 102 Patients

Single site robotic-assisted laparoscopic transperitoneal ligation of ovarian veins for treatment of pelvic congestion syndrome, a case report and review of literature

Single site robotic-assisted laparoscopic transperitoneal ligation of ovarian veins for treatment of pelvic congestion syndrome, a case report and review of literature

Pelvic Congestion Syndrome: Systematic Review of Treatment Success.

Pelvic venous insufficiency is now a well-characterized etiology of pelvic congestion syndrome (PCS). The prevalence of CPP is 15% in females aged 18 to 50 years in the United States and up to 43.4% worldwide. In addition to individual physical, emotional, and quality-of-life implications of CPP, there are profound healthcare and socioeconomic expenses with estimated annual direct and indirect costs in the United States in excess of 39 billion dollars. PCS consists of clinical symptoms with concomitant anatomic and physiologic abnormalities originating in venous insufficiency. The etiology of PCS is diverse involving both mechanical and hormonal factors contributing to venous dilatation (>5 mm) and insufficiency. Factors affecting the diagnosis of PCS include variance of causes and clinical presentations of pelvic pain and relatively low sensitivity of noninvasive diagnostic imaging and laparoscopy to identify insufficiency compared with catheter venogram. A systematic review of the literature evaluating patient outcomes following percutaneous treatment of PCS is presented.

Endovascular treatment for pelvic congestion syndrome associated with inferior vena cava anomaly

Introduction: Pelvic congestion syndrome is described as chronic pelvic pain arising from dilated and refluxing pelvic veins, although the causal relationship between pelvic vein incompetence and pelvic pain is not established. Embolization appears to provide symptomatic relief in the majority of women and is safe. Case report: We report the case of a young woman affected by pelvic congestion syndrome associated with a rare venous anomaly, duplicity of inferior vena cava with azygos vein continuation. Endovascular treatment consisted of detachable coil embolization of the right ovarian vein, as pelvic pain was prevalently on this side. Technical and clinical outcome were positive with a significant improvement of quality of life. Conclusion: This is the first reported case of a pelvic congestion syndrome associated with inferior vena cava anomaly and effectively treated with ovarian vein embolization.

A Modern Radiologic Treatment for Pelvic Congestion Syndrome Associated with Chronic Pelvic Pain and Menstrual Abnormalities

Introduction With greater than one-tenth of outpatient gynecology visits attributed to chronic pelvic pain, research into etiology and management of the spectra of chronic pain disorders is very important. One such etiology, pelvic congestion syndrome (PCS), is a disease in which pelvic varicosities are present as a result of dysfunctional venous valves, retrograde blood flow, venous hypertension, and dilation. The presence of these varicosities, which exist in up to 10% of women between 18 and 76 years of age, can be detected by various imaging techniques including ultrasound, contrasted computed tomography, and magnetic resonance imaging. Various treatment methodologies have been described for the management of this chronic pain disorder, including medical, endovascular, and surgical therapies. With advancements in imaging, and the opportunity for endovascular intervention via interventional radiology, minimally invasive left ovarian vein embolization is at the forefront of therapeutic efforts for this nefarious condition. Methods We present here our clinical experience of 9 patients with PCS who underwent left ovarian vein embolization using a standardized protocol. Results Subjective pain relief was noted in 8 of 9 patients; 7 of the 9 patients reported complete resolution of pain at the 4-week follow-up, and associated symptoms similarly resolved. Conclusions Any thorough evaluation of a patient with chronic pelvic pain should include an evaluation for PCS when the diagnosis is not immediately available. Increased physician awareness of PCS is imperative for the future. With these astounding results, we recommend an excellent option for treatment of patients with left ovarian vein embolization.

Diagnosis and treatment of pelvic congestion syndrome: Single-centre experiences.

One of the underestimated causes of chronic pelvic pain (CPP) in women may be pelvic congestion syndrome (PCS) that is defined as the presence of varicose of ovarian and pelvic veins associated with chronic pain in the region of the pelvis. This pain is present longer than 6 months and intensifies with prolonged standing, coitus and menstruation. The disease constitutes a diagnostic as well as therapeutic problem, thus posing a challenge for the clinician. Transcatheter ovarian vein embolization might be a safe and effective option for PCS treatment. The objective of this study was to evaluate the efficacy of ovarian vein embolization ovarian as a method of the PCS treatment. Between 2002-2012, 11 embolization procedures were performed in 10 women (age range: 34-43; median age 39) with the diagnosis of PCS. One patient underwent embolization procedure twice. In 1 case the combined therapy of endovascular embolization and surgical phlebectomy of vulvar varices was performed. There were no major intrainterventional complications. In all the patients (100%) a significant improvement in the clinical status was noted. The procedure improved the quality of life in the patients. Three women (30%) had a mild recurrence of the symptoms at mid-term follow-up. Among 8 women who had complained of dyspareunia prior to embolization 6 patients reported complete pain relief, in other 2 cases the pain subsided partially. There was a significant decrease in the severity of symptoms associated with hemorrhoids. We consider embolization of insufficient ovarian veins an effective and safe way of treatment in a well-selected group of patients with PCS.

Clinical curative effect observation on functional electrical stimulation combined with biofeedback pelvic floor exercise of pelvic congestion syndrome

Objective : Analyze the curative effect of functional electrical stimulation combined with biofeedback pelvic floor muscle training in the treatment of pelvic congestion comprehensive syndrome. Methods : A retrospective analysis of our hospital during June 2013 to June 2015 45 cases by analgesic drugs and traditional Chinese medicine enema poor treatment of pelvic congestion syndrome in patients with functional electrical stimulation combined with biofeedback pelvic floor muscle training in the treatment, current frequency 10-20Hz period of 200 microseconds pulse, current intensity for 10 ~ 50mA, for 30 min each time, 2 times a week, continuous treatment for 5 weeks. Before and after the treatment of pelvic vein diameter and blood flow rate, as well as the pain score [using the pain score table (VAS)]. Results : Patients in the treatment without adverse reaction and after treatment of pelvic vein diameter (2.9 + 1.6 mm was significantly lower than the treatment of 7.5 + 2.6) mm, P < 0.05, venous blood flow velocity (84.9 + 3.8) mm / s significantly faster than before treatment (53.6 + 2.9) mm / s, P < 0.05. The total effective rate was 91.1%, pain score (2.52 + 1.29) were significantly lower than those before treatment (4.82 + 1.29) (P < 0.05). Conclusion : functional electrical stimulation combined with biological feedback and pelvic muscle exercise can significantly alleviate the pelvic congestion syndrome pain symptoms. The curative effect is distinct and worth popularization in clinical.

Diagnosis and treatment of pelvic congestion syndrome in women with interventional radiology methods

Aim. Evaluation of the results of venography and efficacy of gonadal veins embolization in female patients with pelvic congestive syndrome and concomittant genital pathology. &#x0D; Methods. The study included 61 patients with pelvic varicosities diagnosed on the basis of ultrasound and Doppler studies of the veins with obligatory use of Valsalva test. The average age of the patients was 34.11±0.98 years. Patients were divided into groups according to the presence or absence of concomitant genital pathology: group A - 16 patients with pelvic varicose veins without concomitant genital pathology; group B - 20 patients with pelvic varicose veins and endometriosis; group C - 25 patients with pelvic varicose veins and other genital pathology. All patients underwent selective pelvic vein embolization by the combined method with the use of coils and sclerosants. The variants of anatomical structure of venous system in patients from three groups were clarified according to the results of venography. Efficacy of the method was assessed by the change in pelvic pain intensity according to Visual Analogue Scale before and after embolization. &#x0D; Results. Bilateral pelvic varicose veins in all groups was the most prevalent variant diagnosed in venography. In groups A and C 87.5 and 84% of patients, respectively, noted improvement. In group B 35% of patients reported improvement, while 65% maintained pain after embolization. However, even while maintaining pain, decrease of its intensity was reported by 35% of patients, but in 6 (30%) of cases it required surgical organ-resecting treatment. &#x0D; Conclusion. Venograghy in pelvic congestive syndrome in women is characterized by stagnation of venous blood in the venous system of pelvis with the reflux and valvular incompetence; endovascular method confirmed its high efficiency for relieving pelvic pain syndrome; we had no complications during the study.

Endoscopic Technologies for the Diagnostics and Treatment of Pelvic Congestion Syndrome

Endoscopic Technologies for the Diagnostics and Treatment of Pelvic Congestion Syndrome

Laparoscopic Ovarian Vein Ligation for Treatment of Pelvic Congestion Syndrome

Laparoscopic Ovarian Vein Ligation for Treatment of Pelvic Congestion Syndrome

Effectiveness of Embolization or Sclerotherapy of Pelvic Veins for Reducing Chronic Pelvic Pain: A Systematic Review

PurposeChronic pelvic pain (CPP) in the presence of dilated and refluxing pelvic veins is often described as pelvic congestion syndrome (PCS), although the causal relationship between pelvic vein incompetence and CPP has not been established. Percutaneous embolization is the principal treatment for PCS, with high success rates cited. This study was undertaken to systematically and critically review the effectiveness of embolization of incompetent pelvic veins. Materials and MethodsA comprehensive search strategy encompassing various terms for pelvic congestion, pelvic pain, and embolization was deployed in 17 bibliographic databases, with no restriction on study design. Methodologic quality was assessed. The quality and heterogeneity generally precluded meta-analysis. Results were tabulated and described narratively. ResultsTwenty-one prospective case series and one poor-quality randomized trial of embolization (involving a total of 1,308 women) were identified. Early substantial relief from pain was observed in approximately 75% of women undergoing embolization, and generally increased over time and was sustained. Significant pain reductions following treatment were observed in all studies that measured pain on a visual analog scale. Repeat intervention rates were generally low. There were few data on the impact on menstruation, ovarian reserve, or fertility, but no concerns were noted. Transient pain was common following foam embolization, and there was a < 2% risk of coil migration. ConclusionsEmbolization appears to provide symptomatic relief of CPP in the majority of women and is safe, although the quality of the evidence is low.

Етіопатогенетичний підхід до консервативного лікування варикозного розширення вен малого таза у жінок

Aim of research is clinical, laboratory and instrumental evaluation of efficiency of proposed pathogenetic conservative treatment for Pelvic Congestion Syndrome in women of reproductive age. Complex treatment consisted of oral use of diosmin, chondroitin sulfate for 6 months and physiotherapy. The results of the study suggest that proposed treatment is effective enough. It provides recovery of varicose veins endothelium functions, dynamic balance between vasodilatory and vasoconstrictor factors, normalization of blood rheology and metabolic processes in connective tissue. Key words: Pelvic Congestion Syndrome, conservative treatment, venotonic therapy.

Efficacy of endovascular treatment for pelvic congestion syndrome.

Chronic pelvic pain is not a rare health problem among women. One of the most common causes of chronic pelvic pain is pelvic congestion syndrome (PCS). We have reviewed all medical literature on the endovascular treatment of PCS and hereby provide a brief overview of the anatomy, pathophysiology, and clinical aspects of ovarian and pelvic varices. We describe the technique of transcatheter embolization, the complications thereof and the clinical results of the treatment. A literature search was performed using PubMed, Science Direct, Google Scholar, and Scopus to identify case series on the endovascular treatment of PCS up until the end of November2014. Twenty studies with a total of 1081 patients were included in the review. There were no randomized trials, and only one study included a control group. The immediate technical success rate in the occlusion of the affected veins was 99%. Seventeen studies reported the 1- to 3-month clinical success of 641 patients. Of these, 88.1% reported moderate to significant relief in the symptoms and 11.9% reported little or no relief. In 17 studies, long-term results were reported, and the follow-up varied between 7.3months and 5years. In late follow-up, 86.6% reported relief of the symptoms and 13.6% experienced little or no relief. The immediate success rate for the endovascular treatment of PCS is good and the complication rate low. Most patients report relief in the symptoms for up to 5years after the procedure. However, there are no randomized or high-quality controlled trials, and the level of evidence therefore remains atC.

Abstract No. 652 - Endovascular techniques for pelvic congestion syndrome: a review of traditional and novel approaches

1. Recognize the multi-factorial nature of pelvic congestion syndrome (PCS) and how a variety of anatomical and physiological processes can cause PCS. 2. Understand traditional endovascular options for treatment, including; embolization and sclerotherapy of gonadal and internal iliac veins. 3. Be aware of novel approaches to PCS treatment, including the role of venous stenting in May-Thurner syndrome (MTS), recently described as an etiology for PCS. PCS is often caused by pelvic venous insufficiency (PVI) from incompetent valves in gonadal and pelvic veins. As such, endovascular treatment of PCS is focused on embolization and sclerotherapy of these two distinct, yet overlapping, venous territories. Venous compression syndromes, such as Nutcracker syndrome, have also been implicated in PCS. Recently, MTS has also been recognized to contribute to PCS. In these cases, venous stenting, not embolization, has provided symptomatic relief of PCS symptoms. Treatment techniques for PCS include targeted embolization of select refluxing veins, often the gonadal and/or internal iliac veins. Treatment of gonadal veins can be unilateral or bilateral, and staged treatments are also performed with internal iliac vein embolization based on symptom relief. Common embolization agents include coils and sclerosants. Obliteration of the refluxing vein to within 1 cm of its confluence helps prevent recurrence. Risks include non-target embolization, and worsened pain from embolization related inflammation. Recently MTS has been described as an etiology for PCS, secondary to pelvic venous hypertension. In these cases, left common iliac vein angioplasty/stenting has been successful at treating PCS symptoms. Endovascular treatment of PCS requires an in-depth understanding of PVI in order to provide the most effective approach, most commonly embolization of the refluxing gonadal and/or internal iliac veins. An awareness that iliac vein compression, as seen in MTS, can also be a factor in PCS will help the interventionist provide additional treatments, such as venous angioplasty/stenting.

Clinical outcome of ovarian vein embolization in pelvic congestion syndrome

IntroductionPelvic congestion syndrome (PCS), is a condition associated with ovarian vein (OV) incompetence among other causes. It is manifested by chronic pelvic pain with associated dyspareunia and dysmenorrhea. The diagnosis of PCS is often overlooked and the management can be difficult. Traditional therapy for PCS has included both medical and surgical approaches and more recently endovascular therapy. The aim of this workThe aim of this work was to assess the clinical efficacy of ovarian vein embolization in treatment of PCS associated with OV incompetence and in the management of pelvic varices via catheter directed coil embolization. ConclusionFrom our and previous results, we can conclude that catheter directed OV coil embolization is a feasible procedure for treatment of pelvic congestion syndrome associated with OV incompetence. Presence of bilateral OV incompetence should always be investigated prior this therapy. Further prospective trials are required to assess the full benefits and efficacy of this technique, and to assess which may be the best embolic agent.

First experience of retroperitoneal endoscopic gonadal veins resection in the treatment of pelvic congestion syndrome

First experience of retroperitoneal endoscopic gonadal veins resection in the treatment of pelvic congestion syndrome