What is Pelvic Congestion Syndrome?
Pelvic Congestion Syndrome, also known as Ovarian Vein Reflux or Pelvic Venous Disease, is a medical condition that has been widely underdiagnosed and misunderstood. It’s extremely common and accounts for 10-15% of referrals to gynecologists and pain clinics.
Pelvic Congestion Syndrome is a constellation of symptoms caused when varicose veins develop in the pelvic area. These swollen veins occur because the valves in the veins that control the direction of blood flow are not functioning correctly. These swollen veins may occur after multiple pregnancies, or they may be the result of anatomic abnormalities such as May-Thurner Syndrome.
The primary symptom of Pelvic Congestion Syndrome is pelvic pain that becomes worse when you stand. When you are upright, because of the faulty vein valves, blood can’t flow properly and begins to pool in the pelvis. This results in chronic, deep, debilitating and gradually increasing pain, which often becomes worse as the day goes on.
- Pelvic pain
- Pain before or during your period
- Feeling a sudden need to urinate
- Pain during intercourse
- Enlarged and distorted veins on the buttocks, external genitals (vulva), or thighs
How is Pelvic Congestion Syndrome treated?
At ECCO, we understand that “living with the pain” for months is not an option so we take a unique approach to pelvic pain in women. Our pelvic pain program evaluates all possible causes of your symptoms — uterine, endometrial, cervical, vascular, and neurologic. Once we have pinpointed the real cause of the condition, then we can begin to treat it properly, with therapies that have a proven history of working.
Our primary treatment approach at ECCO is an ovarian vein embolization, a minimally-invasive procedure where patients enjoy a much shorter recovery period.
After imaging diagnosis and clinic consultation, we will perform a venogram with the intention of placing a coil to embolize the affected ovarian vein.
What is Venogram with Intervention?
“Veno” means vein and “Gram” means picture. So, using ultrasound guidance our physicians inject dye into your veins and use X-ray technology to “see” the veins and assess their functionality to determine the correct treatment plan. Once the proper path is determined, a vein in either your arm, leg or neck is then perforated with a hallow needle, using ultrasound guidance. A wire is then advanced, under X-ray guidance, into the vein.
Next, depending on your need, possible interventions include:
- Angioplasty: Specialized balloons can be advanced over the wire and inflated to open blockages or narrowed veins.
- Stent placement: Stents (tubular metal scaffolds) can be placed in the vein to keep it open if the vein cannot stay open on its own.
- Embolization: If indicated, we can use coils or plugs to shut down a non functional vein.
- Thrombolysis: If there is a large amount of clot (known as Deep Vein Thrombosis, or DVT) in the arm, leg, abdomen, etc., a specialized catheter can be temporarily placed within the clot itself which emits a medication that dissolves the clot on contact. This may be done over a 24-hour period involving an ICU stay.
In some cases, Intravascular ultrasound (IVUS) may also be used to evaluate the veins internally.
These interventions are performed as outpatient procedures at ECCO or a local hospital. Depending on the condition being treated, the procedure may require general anesthesia, and in many cases can be done with moderate sedation. Since there are no incisions, recovery time is brief. The main limitation is no heavy lifting (defined as > 15 lbs) for five days following the procedure. Occasionally, temporary blood thinners may be needed following the treatment.
What Makes Pelvic Congestion Treatment Different at ECCO?
Many patients with Pelvic Venous Disease have seen multiple providers and have had multiple imaging studies, but their symptoms persist. Part of the problem is that pelvic pain can have many different causes. Obstetricians often offer hysterectomy as a treatment, but if the cause of the patient’s pelvic pain was vascular, then nothing is accomplished. Similarly, pain specialists may offer injections, but if the cause of the symptoms is not neurologic, then again, the treatment provides no relief.
What conditions are treated with a Venogram?
The list is long, but some of the more common conditions treated are:
- DVT (acute and chronic)
- May-Thurner Syndrome
- Pelvic Congestion Syndrome
- SVC Syndrome