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.