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Review
. 2022 Dec;54(1):22-36.
doi: 10.1080/07853890.2021.2014556.

Comprehensive overview of the venous disorder known as pelvic congestion syndrome

Kamil Bałabuszek  1 , Michał Toborek  1 , Radosław Pietura  1
Affiliations
Review

Comprehensive overview of the venous disorder known as pelvic congestion syndrome

Kamil Bałabuszek et al. Ann Med. 2022 Dec.

Abstract

Pelvic venous disorders (PeVD) also known as Pelvic Congestion Syndrome (PCS) affect a great number of women worldwide and often remain undiagnosed. Gynecological symptoms caused by vascular background demand a holistic approach for appropriate diagnosis. This is a relevant cause of chronic pelvic pain and atypical varicose veins. The diagnosis is based on imaging studies and their correlation with clinical presentation. Although the aetiology of PCS still remains unclear, it may result from a combination of factors including genetic predisposition, anatomical abnormalities, hormonal factors, damage to the vein wall, valve dysfunction, reverse blood flow, hypertension and dilatation. The following paper describes an in-depth overview of anatomy, pathophysiology, symptoms, diagnosis and treatment of PCS. In recent years, minimally invasive interventions have become the method of first choice for the treatment of this condition. The efficacy of a percutaneous approach is high and it is rarely associated with serious complications.Key MessagesPelvic venous disorders demand a holistic approach for appropriate diagnosis.This article takes an in-depth look at existing therapies of Pelvic Congestion Syndrome and pathophysiology of this condition.Embolisation is an effective and safe treatment option.

Keywords: Interventional radiology; chronic pelvic pain; pelvic congestion syndrome; pelvic venous disorders.

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Usual anatomy of venous drainage. Inferior vena cava (IVC), left ovarian vein (LOV), right ovarian vein (ROV), internal iliac veins (IIV) are presented.
Figure 2.
Figure 2.
The simplified diagram of the pathogenesis of PeVD-induced pain.
Figure 3.
Figure 3.
Vulvar varices in patients with PCS in MRI.
Figure 4.
Figure 4.
Atypical varicose veins of two patients due to chronic pelvic venous insufficiency.
Figure 5.
Figure 5.
Grade III reflux in venography. Retrograde flow crossing midline, passing to parauterine plexus on the other side. Catheter in the left ovarian vein indicated by an arrow.
Figure 6.
Figure 6.
MRI,3D IFIR without contrast agent. Frontal section. Inferior vena cava (IVC), left ovarian vein (LOV) and right ovarian vein (ROV), common iliac vein, external iliac vein (EIV), internal iliac vein and its branches are visible.
Figure 7.
Figure 7.
MRI, TRICKS with intravenous administration of contrast agent. Dynamic imaging of the abdominal and pelvic vascular system. (A) Arterial phase; (B) late venous phase with ovarian veins indicated by arrows; and (C) very late venous phases with IVC, right internal vulvar vein and left obturator vein indicated by arrows.
Figure 8.
Figure 8.
Patient after embolisation of the insufficient pelvic veins. Duplication of the left ovarian vein indicated by arrows.
Figure 9.
Figure 9.
Digital Subtraction Angiography was performed using CO2 before embolisation in a patient allergic to contrast.
See this image and copyright information in PMC

References

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