The pelvic congestion syndrome: role of the "nutcracker phenomenon" and results of endovascular treatment

Abstract

Purpose: Pelvic Congestion Syndrome (PCS) is a less known pathologic condition in multiparous women. The major symptoms are: low abdominal pain, dyspareunia or postcoital ache, gluteal or thigh varices, and emotional disturbances. The purpose of this retrospective study is to evaluate the pathogenesis, diagnosis and immediate, and long-term clinical results of the endovascular treatment of PCS.

Methods and materials: From February 1992 until January 2000, 67 diagnostic ovarian vein phlebographies followed by transcatheter embolization were performed in 66 patients with pelvic varicosities. These patients were traced back and submitted to a standardized questionnaire. The data of 48 patients was obtained this way.

Results: In 83%, extrinsic compression of the left renal vein between the aorta and the superior mesenteric artery--known as the "nutcracker phenomenon"--was observed together with congestion of the left ovarian vein and pelvic varicosities. The technical success rate of endovascular embolization was 96%. The initial clinical success rate was 86%, with a long-term benefit for 75% of the patients. After embolization there was a reduction in pain intensity, pain attacks, and emotional disturbances. Globally there was a mean reduction of complaints of 73% (Visual Analog Scale).

Conclusion: The "nutcracker phenomenon" was detected in most of the treated patients and could explain the congestion of the left ovarian vein. Transcatheter embolotherapy is an effective way of treating pelvic varicosities, resulting in a great improvement of the quality of life for most of the patients. In experienced hands the procedure is relatively simple, and it is well tolerated. Moreover it can be performed in one step with the diagnostic phlebographic procedure.