Pelvic Congestion Syndrome (PCS) is a chronic condition in women caused by weakened valves in varicose veins in the lower abdomen or pelvis. This leads to blood flowing backward and pooling in the pelvic and leg veins.
- Aching pain and heaviness in the pelvis, extending to the lower back
- Pain during intercourse.
- Heavy menstrual bleeding.
- Heaviness and swelling in the legs, especially after prolonged standing.
- Recurrent varicose veins.
Primary PCS is believed to be idiopathic but is more common in women 20-50 years old, who have had multiple pregnancies.
Secondary PCS can be associated with Renal Nutcracker Syndrome or Iliac Vein Compression Syndrome (May-Thurner Syndrome).
CT scan of the abdomen and pelvis. Pelvic venogram: A catheter is inserted through the groin vein, and contrast dye is injected into the pelvic veins.
Ovarian Vein Embolization:
A thin catheter is inserted through the femoral vein in the groin.
Using fluoroscopy, the catheter is guided to the affected vein(s).
Tiny titanium coils with a sclerosing agent are inserted through the catheter to close off the affected vein(s).
Ovarian vein embolization is often performed as a day surgery procedure, allowing same-day discharge.
Case Study 1
Patient presented with worsening pelvic and flank pain, and pelvic heaviness. Diagnosed as left renal nutcracker syndrome with pelvic congestion syndrome. She was unable to do sports and had daily pain. The decision was made to perform ovarian vein embolisation.
Balloon angioplasty was first used to widen the narrowed renal veins to treat the nutcracker syndrome. Next, coil embolisation was performed – metallic coils were inserted into the left ovarian veins, along with a sclerosing agent, sealing off the troublesome veins.
Patient’s pain symptoms resolved 24 hours post-procedure, and after one week, was able to return to sports and daily activities without pain.
Case Study 2
Patient presented with deep seated lower back and pelvic pain radiating to lower back and down both inner thighs, to legs and feet. A pelvic MRI showed the presence of uterine adenomyosis, bilateral ovarian cysts, as well as dilated adnexal pelvic veins. Additionally, symptomatic, painful, and engorged varicose veins were observed, and the patient was unable to stand for long periods without pain.
Pelvic, renal and ovarian vein venograms were taken, along with intravascular ultrasounds (IVUS), delineating the affected veins. Left common iliac vein compression was seen at the junction into the inferior vena cava, indicating May-Thurner Syndrome, and reflux was present in the left sided adnexal and iliac veins. The decision was hence made to proceed with embolisation.
Fig 1: Pre and post coil embolisation of left ovarian pelvic veins.
Embolisation of the left pelvic and ovarian vein was done via coiling. Multiple phlebectomies of the leg varicose veins were then performed, removing target segments of veins, and wounds were then closed. Under fluoroscopy guidance, sclerotherapy was performed bilaterally, and sclerosing agent was injected into target varicosities, closing them off.
Pelvic pain resolved in 24 hours. Bilateral leg heaviness and swelling resolved within 1 week.
