Embolization in Pelvic Congestion Syndrome
Pelvic congestion syndrome remains a poorly understood entity whose existence, let alone appropriate methods of investigation and treatment, are still under legitimate question. It is important that any endovascular therapist contemplating ovarian vein em
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Contents
Abstract
1
Introduction.......................................................................... 207
2
Clinical Presentation ........................................................... 208
Pelvic congestion syndrome remains a poorly understood entity whose existence, let alone appropriate methods of investigation and treatment, are still under legitimate question. It is important that any endovascular therapist contemplating ovarian vein embolization works closely with a gynecologist, not only to ensure that other causes of pelvic pain are excluded, but to share in the considerable post procedure needs of these patients. Pelvic congestion syndrome is increasingly being diagnosed both clinically and by imaging in patients with pelvic pain. Referral patterns are changing to include women being screened for lower extremity venous insufficiency. Although there is a striking consistency to the clinical improvement achieved by ovarian vein embolization by multiple authors, it is necessary that any physician undertaking this procedure convey the controversial nature of the syndrome to the patient. Improvement in pain symptoms should be expected in 80–90 % of patients with significant improvement in 60 %. Treatment appears durable at 5-year follow-up. There remains considerable variation in the endovascular approach, and the optimum approach remains to be proven.
3 Preprocedure Workup ........................................................ 208 3.1 Laparoscopy........................................................................... 208 3.2 Cross-Sectional Imaging ....................................................... 208 209 209 209 209 209
4 4.1 4.2 4.3 4.4
Ovarian Venography and Embolization........................... Indications.............................................................................. Contraindications ................................................................... Patient Preparation................................................................. Technique of Ovarian Venography and Embolization ........
5
Results of Embolization ...................................................... 210
6
Complications ....................................................................... 211
References...................................................................................... 211
1
L. Machan (&) Department of Radiology, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada e-mail: [email protected]
Introduction
Embolization of the gonadal vein is one of the simplest procedures in endovascular medicine. Conversely, in clinical medicine, management of chronic pelvic pain is among the most difficult tasks. This is due to the difficulties with diagnosis and treatment detailed in the prior chapter. It is critical to reiterate that although varicosities in the pelvis secondary to ovarian vein reflux are a recognized cause of chronic pelvic pain (Cheong and Stones 2006), they are frequently seen incidentally on imaging studies in asymptomatic women. Without as
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