Treatment Of Pelvic Congestion Syndrome Research Articles

Pelvic congestion syndrome: increasing awareness is the key to facilitating proper diagnosis and appropriate treatment

Pelvic Congestion Syndrome (PCS) represents a complex and frequently misdiagnosed disease that may greatly impact on quality of life of affected patients. An understanding of its complex nature is crucial for both an accurate diagnosis and effective management. In the present paper, a comprehensive overview of the clinical presentation, diagnostic strategies, and the latest advancements in the treatment of PCS is provided. Our aim is to raise awareness of treating physicians, improve proper diagnosis, and promote appropriate treatment.

Pelvic congestion syndrome and its treatment: topic review

Pelvic congestion syndrome (PCS) is a pathology characterized by pain in the pelvic region that occurs chronically and is usually associated with the presence of varicose veins in the genital, vulvar or perineal region as a consequence of venous reflux of gonadal, gluteal or peri uterine veins, as well as compression syndromes in the left renal veins or iliac segments, which can lead to a spectrum of clinical symptoms ranging from dysuria, pain when standing, dyspareunia and intense dysmenorrhea, or equally psychological symptoms such as mood disorders or depression, which affect the quality of life of patients. Despite its high prevalence, this disease continues to be underdiagnosed and mistreated. The etiology varies involving factors in mechanics, hemodynamics, anatomical defects, anomalies of venous return, multiparity, including hormonal factors, obesity, or sedentary lifestyle, which favor blood stasis and consequent venous dilation. The diagnosis is made with an appropriate clinical examination, and confirmed with imaging studies, phlebography being the gold standard due to its diagnostic and therapeutic usefulness. There is currently a wide variety in the treatment of PCS, however endovascular management with sclerotherapy and embolization is the one that has shown the best results with clinical improvement and quality of life. This article seeks to review the literature on pelvic congestion syndrome with the aim of understanding a frequently overlooked disease and the diagnostic and therapeutic alternatives to treat these patients.

Diagnostics and treatment of pelvic congestion syndrome

Diagnostics and treatment of pelvic congestion syndrome

Análise da eficácia do tratamento endovascular com escleroterapia por espuma na síndrome de congestão pélvica através de avaliação por ultrassonografia

Abstract Background Pelvic Congestion Syndrome is an important cause of pelvic pain in adult women, leading to reduced quality of life, absenteeism from work, anxiety, depression, and sexual disorders. Objectives To evaluate the response to endovascular treatment for pelvic varicose veins using foam sclerotherapy and outline the profile of patients with this diagnosis followed up at the Hospital das Clínicas Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Brazil. Methods Based on review of medical records, this retrospective descriptive study analyzes the profile and response of patients undergoing endovascular treatment for pelvic varicose veins by foam sclerotherapy. The variables analyzed include age, weight, height, body mass index, parity, pelvic pain complaints, ultrasound criteria comparing the diameter of pelvic vessels before and after the procedure, and presence of venous reflux on transvaginal Doppler ultrasound. Results The sample of patients analyzed had an average age of 43.3 years old, a mean of 2.95 gestations, and a mean BMI of 25.37kg/m2. Ultrasound assessment after the intervention indicated a statistically significant reduction (p-value < 0.005) in the caliber of the parauterine vessels, with mean diameters of 6.34 mm on the right and 7.26 mm on the left before the procedure and 4.37 mm and 4.56 mm respectively afterwards. Conclusions Foam sclerotherapy reduced the caliber of pelvic varicose veins in the study sample. The results were similar to those of other endovascular treatment methods for this comorbidity. Further prospective studies to assess the response to this intervention are necessary to establish it as an effective option for treatment of pelvic congestion syndrome.

Pain reduction as the main parameter for monitoring improvement in Health-Related Quality of Life (HRQoL) following endovascular treatment of Pelvic Congestion Syndrome (PCS)

The purpose of this study was to evaluate pain reduction as the main parameter for monitoring improvements in Health-Related Quality of Life (HRQoL) in a female patient following endovascular treatment of Pelvic Congestion Syndrome (PCS).A 38-year-old female patient with chronic intermittent, “dragging” abdominal pain, lasting more than two years, mainly in the lower abdomen, radiating to the sacral region, underwent SARS CoV-2 infection in October 2021, and COVID-19, which lasted 10 days. Eight months later, complaints of pain in the lower abdominal area, during the mentrual cycle, during prolonged standing, after sports activities and during and after intercourse, increased. The patient was compelled to begin diagnosis of these complaints due to the severe pain and concerns about whether she had contracted cancer of the cervix uteri. She was diagnosed on transvaginal ultrasound-Doppler and Angio-MR of the pelvic vessels with PCS. Treatment was undertaken at the Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland. Intraoperatively, after confirmation through selective angiography, of previously diagnosed insufficiency of the left ovarian vein (LOV) and of the parametrial veins (PMV), the selective obliteration was performed with an adhesive dedicated to endovascular closure of veins and vascular malformations (Glubran2). The range of pain intensity, according to theVisual Analogue Scale (VAS), in Exam. 1 (before surgery), was in the premenstrual period (BM) 7.0 points, which increased during menstruation (DM) or after intense activity (AIA) to 8.0 points, and occasionally during and after intercourse even to 9.0 points. These values were very high, indicating that pain significantly affected the patient's quality of life. The extent of pain severity decreased significantly in Study 2 (two months after surgery) and Study 3 (four months after surgery) and was 2.0 points in the premenstrual period (BM), which increased only slightly during menstruation (DM) or after intense activity (AIA) to 3.0 points, and decreased again to 2.0 points during and after intercourse. The patient reported that the procedure significantly and positively affected her functioning in daily life, especially in caring for a young child, which is evidence of the achievement of HRQoL improvement.Endovascular treatment for Pelvic Congestion Syndrome (PCS) was effective in reducing pain and improving the Health-Related Quality of Life (HRQoL) of a patient with PCS.

Abstract No. 150 Endovascular Treatment of Pelvic Congestion Syndrome (PCS) in 246 women, Long Term Results, and Analysis of Patient Satisfaction

Abstract No. 150 Endovascular Treatment of Pelvic Congestion Syndrome (PCS) in 246 women, Long Term Results, and Analysis of Patient Satisfaction

Foam Sclerotherapy in Pelvic Congestion Syndrome.

Chronic pelvic pain (CPP) is a prevalent condition in middle-aged women that represents a heavy social impact on the quality of life of those females. Treatment of pelvic congestion syndrome is a complex and controversial issue, but treatment can be one of 3 lines: medical therapy, endovascular treatment, and surgical intervention. The endovascular line was first introduced in 1993 and has been popular over other lines of treatment methods. This retrospective study was conducted in a tertiary university hospital over 24 months, from March 2019 to March 2021. Forty patients with PGS were managed by left ovarian vein TCFS. The Institutional Review Board waived the need for ethics approval or informed consent to use anonymized and retrospectively analyzed data. The mean age of enrolled women was 33.80 ± 6.54years, ranging between 20 and 45years. Trans-catheter ethanolamine foam embolization is an effective and safe method to treat pelvic and atypical lower limb varices.

Successful Treatment of Pelvic Congestion Syndrome with Plug Embolization of Pelvic Incompetent Veins: 7 Cases Report

Successful Treatment of Pelvic Congestion Syndrome with Plug Embolization of Pelvic Incompetent Veins: 7 Cases Report

Pelvic congestion syndrome – case report

Pelvic congestion syndrome is unfortunately an often-misdiagnosed disorder that causes chronic pelvic pain in women of fertile age. The main symptoms are represented by chronic pelvic discomfort or pain. This pathology appears to be related to a venous disorder generating pelvic varicosities. There are no standardized diagnosis criteria or treatment guidelines to aid in the management of pelvic congestion syndrome. The therapeutic options consist in medical or surgical treatment, sclerotherapy and endovascular treatment. We present the case of a 33-year-old woman with a severe case of pelvic congestion syndrome, that has affected her both physically and emotionally. The patient received specialized treatment in a Spanish medical unit, with subsequent improved symptoms. We concluded that should be founded specialized centres in our country for the diagnosis and treatment of pelvic congestion syndrome so that these young patients could embrace a normal, painless life.

Endovascular Treatment of Pelvic Congestion Syndrome: Visual Analog Scale Follow-Up.

Purpose: To evaluate medium-term clinical outcomes of transcatheter embolization and stenting in women with several pelvic venous disorders responsible for chronic pelvic pain and varicose veins of the lower limbs.Materials and Methods: The study population included 327 consecutively recruited patients referred to the interventional radiology unit from January 2014 to December 2019 due to chronic pelvic congestion (91; 27.83%), lower limb varices (15; 4.59%), or a combination of both the symptoms (221; 67.58%). Preprocedural pelvic, transvaginal Doppler ultrasound (US), and MRI were conducted in all the patients and revealed anatomical varicosities and incompetent pelvic veins in 312 patients. In all the patients, selective catheterization demonstrated uterine venous engorgement, ovarian plexus congestion, or pelvic vein filling. Retrograde flow was detected on catheter venography in the left ovarian vein (250; 78%), the right ovarian vein (85; 26%), the left internal iliac vein (222; 68%), and the right internal iliac vein (185; 57%). Patients were followed-up at 1, 6, and 12 months, and years thereafter systematically by the referring angiologist and the interventional radiologist of center. They were contacted by telephone in November and December 2020 to assess pain perception and quality of life by using the visual analog scales from 0 to 10 with assessments made at the baseline and last follow-up. Of the 327 patients (mean age, 42 ± 12 years), 312 patients were suffering from pelvic congestion syndrome and 236 patients was suffering from lower limb varices. All underwent embolization by using ethylene vinyl alcohol copolymer (Onyx®). Eighty-five right ovarian veins, 249 left ovarian veins, 510 tributaries of the right internal iliac vein, and 624 tributaries of the left internal iliac vein were embolized. A cohort of patients also underwent nutcracker syndrome angioplasty (6.7%) and May–Thurner syndrome angioplasty (14%) with a stent placement.Results: The initial technical success rate was 80.9% for embolization of pathological veins and 100% for stenting of stenoses. Overall, 307 patients attended 12-month follow-up visits and 288 (82%) patients completed the telephone survey at mean 39 (±18)-month postintervention. Main pelvic pain significantly improved from 6.9 (±2.4) pre- to 2.0 (±2.4) postembolization (p < 0.001), as did specific symptoms in each category. Improvement or disappearance of pain was achieved in 266/288 (92.36%) patients with improved quality of life in 276/288 (95.8%) patients. There were 16 minor and 4 major adverse events reported on the follow-up.Conclusion: Pelvic vein embolization (Onyx®) is an effective and safe procedure with high clinical success and quality of life improvement rates.

Advances of Laparoscopy for the Diagnosis of Pelvic Congestion Syndrome.

The objective of this review is to describe the effectiveness of laparoscopy in the diagnosis and treatment of pelvic congestion syndrome (PCS). PCS is a cause of chronic pelvic pain (CPP) and is associated with dysfunction of the pelvic venous system. PCS is more common in women of reproductive age, and hormonal changes are associated with its development along with other reasons (e.g., working and living habits). There is an urgent need to establish an effective algorithm for the diagnosis and treatment of CPP, which could have a dramatic effect in patients’ everyday life. This algorithm should be able to overcome known issues that lead to the underdiagnosis of PCS, such as the overlap of its symptoms with other diseases. Here, we present our findings from literature articles about the methods used in practice today for the diagnosis of this syndrome. We also compare the methods to propose the most promising technique for providing a diagnosis with high accuracy. In our understanding, laparoscopy is superior when compared to other methods. It can provide a diagnosis of PCS while excluding or identifying other comorbidities and can also lead toward the next steps for the treatment of PCS.

Pelvic congestion syndrome: historical aspects and a modern view on the problem (a literature review)

Pelvic congestion syndrome is a relatively recent, but actual and separate nosological form. Pelvic varicocele is a form of varicose disease, which is increasingly regarded as the main cause of chronic pelvic pain in women with various clinical manifestations. A woman with chronic pelvic pain is a difficult patient with combative behavior, who contacts with physicians in various specialties. There are many causes of chronic pelvic pain, but pelvic congestion syndrome has a special place. In recent years, in addition to widespread use of diagnostic radiology, the relevance of this pathology is beyond any doubt. The aim of the study was to summarize and present literature data on the etiology, pathogenesis, clinical manifestations, diagnosis and treatment of pelvic congestion syndrome by analyzing the literature data. Materials and methods. A non-systematic review was conducted using PubMed, Web of Science, Google and Google Scholar databases. The review included free full-text articles published between 1974 and 2021 using key words: pelvic congestion syndrome, pelvic varices, pelvic venous disorders, pelvic varicocele, pelvic venous stasis, chronic pelvic pain, gonadal veins, ovarian veins, vena ovarica, Nutcracker syndrome, May–Thurner syndrome. Conclusions. Pelvic congestion syndrome is still a rarely diagnosed pathology in patients with chronic pelvic pain. Detailed medical history, physical examination as well as maintaining diagnostic algorithm would allow the disease to be diagnosed correctly and timely. The choice of method for surgical intervention is a key point in the treatment of patients with pelvic congestion syndrome, but today there are no criteria for the choice of one, so the problem is far from being resolved and requires further study and research.

Pelvic congestion syndrome (PCS) as a pathology of postmenopausal women: a case report with literature review

BackgroundDue to the scarcity of adequately powered, randomized controlled trials and internationally standardized diagnostic criteria, evidence on the diagnosis and treatment of pelvic congestion syndrome (PCS) is limited. Earlier epidemiologic observations led to the attribution of PCS to the premenopausal state, and a remission of symptoms after menopause is frequently described a hallmark of the pathology. This concept has currently been challenged by radiological studies reporting a notable prevalence of ovarian venous congestion in adult female patients of advanced age. PCS as a pathology of postmenopausal women, however, has not been acknowledged by systematic research to date, impeding appropriate diagnostics and therapy for affected patients.Case presentationA 69-year-old postmenopausal patient presented with newly diagnosed dilated and insufficient pelvic veins in combination with characteristic pain anamnesis, thereby fulfilling the diagnostic criteria of PCS. Interventional coil embolization of both ovarian veins as a standard treatment previously described for premenopausal patients was successfully performed, resulting in prompt alleviation of symptoms. The patient remained symptom-free at the 18-month follow-up visit.ConclusionsGiven this first systematically documented case of a patient with postmenopausal symptomatic PCS in the light of recently published data on the prevalence of ovarian venous congestion in patients of advanced age, it may be assumed that PCS is not to be considered a pathology strictly limited to premenopausal state. Further clinical studies expanding the diagnostic scope beyond menopause may help to substantiate evidence and subsequently define standardized therapeutic approaches for affected postmenopausal patients.

Pelvic Congestion Syndrome: Surgical Treatment

Aims: To evaluate the mid and long term efficacy of surgical interruption of the refluxing ovarian veins as a treatment modality for pelvic congestion syndrome. Study Design: A prospective non comparative interventional study. Place and Duration of Study: This study was conducted between February 2015 and October 2019 in Alexandria Medical Centre and Tanta Main University Hospital. Methodology: The study included a 27 patient’s undergone surgical interruption of refluxing ovarian veins with or without sclerotherapy of vulval, perineal or thigh varices, and data were collected prospectively. Detailed history was taken and clinical examination was done for every patient along with routine laboratory investigations and radiological work up was transvaginal and abdominal venous duplex. Follow up was done considering the change in pelvic venous images and pelvic pain scores in comparison to the pre-operative state. Results: Twenty seven female patients were treated for pelvic congestion syndrome using single session surgical intervention with or without sclerotherapy to pudendal varices. The patients age ranged from 21 to 43 (mean 33.1). All patients presented with chronic continuous pelvic pain. Other associated symptoms as dyspareunia, dysmenorrhea and pudendal varices were found in some cases. Surgical ligation of the ovarian veins were done to all cases, sclerotherapy/ligation of internal iliac varices was done for 6 cases and scerotherapy or surgical interruption of pudendal or thigh varicose veins was done in 21 cases. Technical success was achieved in all patients. Mean pelvic pain score was improved from 7.33 preoperatively to 1.33 and 0.89 in 6 and 12 months of the post-operative recordings. On sonographic basis pelvic reflux disappeared in 26 patients by the end of the follow up. Out of 27 patients treated there were 24 patients satisfied of the procedures at the end of the follow up. Conclusion: Surgical treatment for pelvic congestion syndrome combined with sclerotherapy to the associated varices was found to be effective, safe and affordable modality of treatment.

Liquid and Solid Embolic Agents in Gonadal Veins.

Male varicocele and pelvic congestion syndrome (PCS) are common pathologies with high predominance in young patients, having a high impact on the quality of life and infertility. Lately, the use of different endovascular embolization techniques, with various embolizing agents, shows good technical results and clinical outcomes. With the aim of presenting the “state of the art” of endovascular techniques for the treatment of male varicocele and PCS, and to discuss the performance of the different embolic agents proposed, we conducted an extensive analysis of the relevant literature and we reported and discussed the results of original studies and previous meta-analyses, providing an updated guide on this topic to clinicians and interventional radiologists. We have also underlined the technical aspects for the benefit of those who approach this type of interventional treatment. Our review suggests promising results in both the endovascular embolic treatment of male varicocele and PCS; for varicocele, a success rate of between 70% and 100% and a recurrence rate of up to 16% is reported, while for PCS it has been found that technical success is achieved in almost all cases of endovascular treatment, with a highly variable recurrence rate based on reports. Complications are overall rather rare and are represented by periprocedural pain, migration of embolic media and vascular perforations: severe adverse events have been reported very rarely.

Patient Satisfaction with Endovascular and Surgical Treatment for Pelvic Congestion Syndrome

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить удовлетворенность пациентов с синдромом тазового венозного полнокровия (СТВП) эндоваскулярным и эндоскопическим лечением. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В проспективное когортное исследование включены 100 пациентов с СТВП, перенесших эндоваскулярную эмболизацию (ЭЭГВ) и эндоскопическую резекцию (ЭРГВ) гонадных вен в 2012—2020 гг. ЭЭГВ спиралями выполнена 71 пациенту (1-я группа), ЭРГВ — 29 пациентам (2-я группа). С целью оценки удовлетворенности проведенным эндоваскулярным и эндоскопическим лечением пациентам было предложено оценить утверждения, касающиеся проведенных операций и сформулированные в пятиточечной анкете Likert. Анкетирование проводили через 7 сут и через 6 мес после вмешательств. <h3>РЕЗУЛЬТАТЫ</h3> Через 7 сут после ЭРГВ, согласно анкете Likert, 100% больных были полностью удовлетворены проведенной операцией, после ЭЭГВ — 80,3% (<i>p</i>=0,01). Полную неудовлетворенность лечением высказали 19,7% больных 1-й группы, что было связано с развитием постэмболизационного синдрома. Через 6 мес после вмешательств 100% пациентов обеих групп были удовлетворены лечением. Суммарная балльная оценка лечения пациентами по всем утверждениям анкеты Likert через 6 мес возросла в обеих группах больных по сравнению с наблюдением через 7 сут (с 20,7 до 22,4 балла (<i>p</i>=0,015) в 1-й группе; с 18,4 до 22,0 балла (<i>p</i>=0,011) во 2-й группе). Оценки проведенного лечения пациентами обеих групп через 6 мес существенно не различались, что подтверждает эффективность и безопасность ЭЭГВ и ЭРГВ. <h3>ЗАКЛЮЧЕНИЕ</h3> Применение эндоваскулярных и эндоскопических вмешательств на гонадных венах при СТВП сопровождается высокими показателями удовлетворенности пациентов лечением.

Pelvic vein embolization: an assessment of the readability and quality of online information for patients

IntroductionPelvic congestion syndrome is a controversial topic. Pelvic vein embolization is a minimally invasive treatment for pelvic congestion syndrome. We aimed to assess the quality of information available on the Internet and determine how accessible information provided by the main IR societies was to patients.Materials and methodsThe most commonly used term relating to pelvic vein embolization was searched across the five most-used English language search engines, with the first 25 web pages returned by each engine included for analysis. Duplicate web pages, nontext content and web pages behind paywalls were excluded. Web pages were analyzed for quality and readability using validated tools: DISCERN score, JAMA Benchmark Criteria, HONcode Certification, Flesch Reading Ease Score, Flesch–Kincaid Grade Level, and Gunning–Fog Index.ResultsThe most common applicable term was “Pelvic Vein Embolization”. Mean DISCERN quality of information provided by websites is “fair”. Flesh–Kincaid readability tests and Gunning–Fog Index demonstrated an average “college level” of reading ease. HON code certification was demonstrated in less than one third of web pages. Professional societies and scientific journals demonstrated the highest average JAMA and DISCERN scores, while for-profit organizations and healthcare providers demonstrated the lowest. Only information from 1 of 3 interventional societies was included in the first 25 search engine pages.ConclusionThe quality of information available online to patients is “fair” and outside of scientific journals the majority of web pages do not meet the JAMA benchmark criteria. These findings call for the production of high-quality and comprehensible content regarding interventional radiology, where physicians can reliably direct their patients for information.

Pelvic Congestion Syndrome

Pelvic congestion syndrome (PCS) is often an underdiagnosed cause of chronic pelvic pain in female patients with radiology detection of gonadal vein dilatation and parauterine varices. It may occur either alone or in combination with vulvar varicosities and/or lower extremity venous insufficiency. Although transcatheter venography represent the gold standard for PCS diagnosis, it is performed after inconclusive noninvasive imaging such as Doppler Ultrasound, CT scan, and MRI. Once diagnosis has been confirmed, management of PCS include medical, surgical, and endovascular therapy. Medical and surgical treatments have been shown to be less effective than transcatheter pelvic vein embolization. This latter has been proven to be a safe, effective, and durable therapy for the treatment of PCS. Numerous studies have shown their results in PCS endovascular treatment, but neither of them has been subjected to an adequate randomized controlled trial. A well-designed randomized controlled trial is urgently needed to assess transcatheter embolization clinical success.

Comprehensive review of pelvic congestion syndrome: causes, symptoms, treatment options.

The purpose of this publication is to review the currently available and most up-to-date information regarding the pathogenesis, diagnosis, and treatment of pelvic congestion syndrome. The diagnosis of pelvic congestion syndrome is difficult to make; however, it should remain on the differential for chronic pelvic pain. The most recent available research seems to favour endovascular treatment with interventional radiology over surgical management, with high success rate and low occurrence of complications. High-level evidence on the diagnosis and management of pelvic congestion syndrome is lacking. Only a small number of randomized controlled trials exist. More high-quality research is needed, particularly involving practicing obstetrician and gynecologists as the majority of these patients, and the clinical outcomes of any interventions implemented for pelvic congestion syndrome are ultimately managed by OB/GYN providers.

Comparative analysis of the efficacy and safety of endovascular and endoscopic interventions on the gonadal veins in the treatment of pelvic congestion syndrome

ObjectiveComparison of the efficacy and safety of endovascular and endoscopic interventions on the gonadal vein in the treatment of patients with pelvic congestion syndrome (PCS). MethodsWe evaluated the treatment outcomes in 95 patients with PCS who underwent endovascular embolization of gonadal veins (EEGV) (group 1, n = 67) or endoscopic resection of the gonadal veins (ERGV) (group 2; n = 28). A comparative analysis of the efficacy and safety of EEGV and ERGV in the treatment of PCS included assessments of their effects on pelvic venous pain, pelvic venous reflux, diameter of the pelvic veins, and restoration of daily activity, as well as treatment safety assessment. Clinical examinations and ultrasound studies of the pelvic veins were repeated at 1, 10, and 30 days, and 36 months after EEGV and ERGV. Pain was assessed using a visual analogue scale and the Von Korff questionnaire. ResultsA decrease in pelvic venous pain intensity was observed at 3.6 ± 1.4 days after EEGV and 2.5 ± 0.8 days after ERGV (P = .49 between the groups). At 1 month after the intervention, a complete relief of pelvic pain was reported by 52 and 25 patients in the EEGV and ERGV groups, respectively. The rates of valvular incompetence of the uterine veins were decreased from 85% in both groups at baseline to 3% in group 1 and 0% in group 2 at 36 months after the intervention, respectively. In the early postprocedural period, pain in the femoral or jugular vein puncture site was reported by eight patients (12%) who underwent EEGV (2.2 ± 0.7 scores). Postembolization syndrome was diagnosed in 13 patients (19.4%). After ERGV, all patients experienced pain in the area of the surgical wound, with a severity of 3.9 ± 0.5 scores. Hematoma at the puncture site of the main vein was observed in 6% of patients after EEGV. Protrusion of coils was identified in three patients (4.5%). The VTE incidence was four times greater in group 1 vs group 2 (14 vs 3 patients; P < .05). The relative risk of this complication after EEGV was 1.4 (95% confidence interval, 1.146-1.732). In two patients (7.1%) after the bilateral laparoscopic resection of the gonadal veins, an ileus developed. No complications of anesthesia were observed in either group. ConclusionsEndovascular and endoscopic techniques for decreasing blood flow through the gonadal veins are effective and safe in treating the PCS. The obvious advantages of EEGV are minimal injury and possibility to perform procedure under local anesthesia. The ERGV is associated with at least similar and, in some cases, even superior outcomes, in the terms of significantly (P < .05) shorter time to the postprocedural pain relief and avoiding postembolization syndrome.