Pelvic Venous Congestion Syndrome

Pelvic Venous Congestion Treatment in Hyderabad

Pelvic venous congestion syndrome, also known as ovarian vein reflux, causes chronic pelvic pain in women. Chronic pelvic pain occurs in the lower abdomen for a long period of time. Pelvic venous congestion syndrome (PVCS) is a painful condition often caused by dilation of the ovarian and/or pelvic veins. 

Normally, the blood is pumped from the legs, through the veins in the pelvis and abdomen to the heart, and the blood flows to the ovaries through the ovarian veins. When the valves in the veins stop working or there is an obstruction to the flow of blood in the veins, the blood may then flow backwards. This causes the development of varicose veins in the pelvis around the ovaries, vulva, and inner thighs and legs, resulting in PVCs.

CARE Hospitals offer comprehensive and thorough diagnosis and understanding of diseases to patients with a wide spectrum of medical needs. Our multidisciplinary team of doctors consisting of medical and surgical nephrologists, anesthesiologists, and care providers with vast knowledge in their fields take immense care to provide appropriate treatments using state-of-the-art equipment by following international standards of protocols to help deliver the desired results and take postoperative end-to-end care for faster and safer recovery, and shorter hospital stays.

Causes

Pelvic venous congestion syndrome commonly occurs in young women who have given birth 2-3 times. During pregnancy, the ovarian vein can be compressed due to the enlarging womb or enlarged because of increased blood flow. This can affect the valve in the veins causing them to stop working and allowing the flow of blood backwards, contributing to PVCS. It may also be associated with polycystic ovarian syndrome. The absence of the vein valves may also be a contributing factor in causing PVCS. 

Symptoms

The symptoms of PVCS is due to dilation of pelvic veins. The varicose veins in the pelvis surround the ovary and can also put pressure on the bladder and rectum. This can cause some of the following symptoms:

• Pain in the region around the pelvis and lower abdomen,

• Pulling or dragging sensation or pain in the pelvis,

• Feeling fullness in the legs,

• Worsening of stress incontinence,

• Worsening of the symptoms associated with irritable bowel syndrome.

Pain is the most common symptom of PVCS and is present for around 6 months or more, and is usually felt on one side but sometimes it can be on both sides of the body. The pain worsens during standing, cycling, lifting, during pregnancy or intercourse. The pain can also be due to menstrual cycles or hormones and can increase in intensity during this time. The pain can improve while lying down.

Sometimes, many women may not experience this pain apart from only during pregnancy which may subside after pregnancy but can worsen over time.

Diagnosis

Our medical specialists of all disciplines take great care to perform appropriate tests and deliver a proper diagnosis for providing treatment options accordingly. Our doctors may suspect some symptoms of pelvic venous congestion syndrome in patients and recommend some tests. Many women may have a history of varicose veins around the vulva during pregnancy, which on examination may reveal to have extended down the inner thighs. 

Non-invasive methods of diagnosis such as ultrasound imaging may be performed to detect abnormal veins. Sometimes when the veins in the pelvis may be difficult to see, a special method of ultrasound, known as transvaginal ultrasound may be required to perform. CT scan or an MRI imaging may also be required to allow doctors to view the varicose veins and recommend an appropriate treatment plan.

Pelvic venography may also be performed to diagnose PVCS and assess the anatomy before any treatment plan is considered. This is a safe, simple, and minimally invasive method that is done by injecting a contrast dye that can be seen through an x-ray machine. This procedure is performed under local anesthesia and requires the insertion of a catheter in the ovarian and pelvic veins.

Treatment

As the first line of treatment, our highly experienced, board-certified medical nephrologists may recommend medical drug treatments such as medroxyprogesterone acetate or more recently, goserelin, which have shown almost 75% efficiency in reducing pelvic pain and reducing the size of the varicose veins. However, the usual treatment of pelvic venous congestion syndrome is percutaneous transcatheter or pelvic pain embolisation. Other treatment options available are open or laparoscopic surgery to tie problematic veins.

What is pelvic pain embolisation and how is it performed?

Pelvic pain embolisation is a minimally invasive procedure performed by our specially trained interventional radiologist. It is usually performed in the radiology department and uses a fluoroscopy machine that allows x-ray images to be converted into video images so that the interventional radiologist may guide the progress of the procedure.

This procedure may require the collaborative effort of other medical specialists such as a cardiologist to monitor heart health and blood pressure, and an anaesthesiologist who performs local anesthesia. A catheter may be inserted through a nick in the skin to see if there is any abnormality and can be used for treatment by sealing or tying the problematic veins permanently by using a synthetic material or medication called embolic agents. There are several embolic agents used in this type of procedure and the use of these agents depends on the size of the blood vessels or how much treatment is needed. These embolic agents have been used for a long period of time and are safe and effective. Some of the embolic agents used in interventional radiology are:

• Coils- Coils made of different materials including stainless steel or platinum. They come in various sizes and can block larger vessels.

• Liquid sclerosing agents- These agents clot blood in the blood vessels and close the veins up.

• Liquid glue- This type of substance is inserted into the vein where it hardens and closes the veins.

What technology is used during the procedure of Pelvic Venous Congestion Syndrome?

Several technologies used in the diagnosis and treatment of Pelvic Venous Congestion Syndrome (PVCS), including:

• Ultrasound Imaging: Transvaginal or transabdominal ultrasound is often used to visualize pelvic veins and identify any abnormalities or reflux.
• Computed Tomography (CT) or Magnetic Resonance Imaging (MRI): These imaging techniques provide detailed views of pelvic veins, helping to confirm the diagnosis and plan treatment.
• Venography: This invasive procedure involves injecting contrast dye into pelvic veins and imaging them using X-rays to assess blood flow and identify reflux.
• Endovascular Techniques: Minimally invasive procedures such as embolization or sclerotherapy may be used to treat PVCS. These techniques involve inserting a catheter into the affected veins and blocking them or injecting a sclerosing agent to shrink them.
• Fluoroscopy: During endovascular procedures, real-time X-ray imaging (fluoroscopy) guides the placement of catheters and monitoring of treatment progress.
• Intravascular Ultrasound (IVUS): This technology may be used during endovascular procedures to provide detailed images of pelvic veins from within, aiding in precise catheter placement and treatment delivery.
• Laser Ablation: In some cases, laser energy may be used to ablate or close off problematic pelvic veins, reducing symptoms associated with PVCS.

Recovery and aftercare

Our multidisciplinary staff of well-experienced doctors and care providers ensure complication-free recovery and shorter hospital stay for patients undergoing pelvic pain embolisation. Patients may be discharged the same day after checking for any other problems. Follow-up appointments may be recommended to check whether the treatment has been a success, and to address any side effects that a patient may have suffered as a result of the treatment or medications used.