Skip to main content
SpringerLink
Log in

Endovascular Treatment of Pelvic Congestion Syndrome: Visual Analog Scale (VAS) Long-Term Follow-up Clinical Evaluation in 202 Patients

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

This study was designed to evaluate the clinical outcome and patients’ satisfaction after a 5 year follow-up period for pelvic congestion syndrome (PCS) coil embolization in patients who suffered from chronic pelvic pain that initially consulted for lower limb venous insufficiency.

Methods

A total of 202 patients suffering from chronic pelvic pain were recruited prospectively in a single center (mean age 43.5 years; range 27–57) where they were being treated for lower limb varices. Inclusion criteria were: lower limb varices and chronic pelvic pain (>6 months), >6 mm pelvic venous caliber in ultrasonography, and venous reflux or presence of communicating veins. Both ovarian and hypogastric veins were targeted for embolization. Pain level was assessed before and after embolotherapy and during follow-up using a visual analog scale (VAS). Technical and clinical success and recurrence of leg varices were studied. Patients completed a quality questionnaire. Clinical follow-up was performed at 1, 3, and 6 months and every year for 5 years.

Results

Technical success was 100 %. Clinical success was achieved in 168 patients (93.85 %), with complete disappearance of symptoms in 60 patients (33.52 %). Pain score (VAS) was 7.34 ± 0.7 preprocedural versus 0.78 ± 1.2 at the end of follow-up (P < 0.0001). Complications were: groin hematoma (n = 6), coil migration (n = 4), and reaction to contrast media (n = 1). Twenty-three cases presented abdominal pain after procedure. In 24 patients (12.5 %), there was recurrence of their leg varices within the follow-up. The mean degree of patients’ satisfaction was 7.4/9.

Conclusions

Coil embolization of PCS is an effective and safe procedure, with high clinical success rate and degree of satisfaction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Robinson JC (1993) Chronic pelvic pain. Curr Opin Obstet Gynecol 5:740–743

    PubMed  CAS  Google Scholar 

  2. Cordts PR, Eclavea A, Buckley PJ et al (1998) Pelvic congestion syndrome: early clinical results after transcatheter ovarian vein embolization. J Vasc Surg 28:862–868

    Article  PubMed  CAS  Google Scholar 

  3. Liddle AD, Davies AH (2007) Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices. Phlebology 22:100–104

    Article  PubMed  CAS  Google Scholar 

  4. Jung SC, Lee W, Chung JW et al (2009) Unusual causes of varicose veins in the lower extremities: CT, venographic and Doppler US findings. Radiographics 29:525–536

    Article  PubMed  Google Scholar 

  5. Ahumada M, Vioque J (2004) Prevalence and risk factors of varicose veins in adults. Med Clin 123:647–651

    Google Scholar 

  6. Meissner MH, Gloviczki P, Bergan J et al (2007) Primary chronic venous disorders. J Vasc Surg 46:54S–67S

    Article  PubMed  Google Scholar 

  7. Carpentier PH, Maricq HR, Biro C et al (2004) Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France. J Vasc Surg 40:650–659

    Article  PubMed  Google Scholar 

  8. Kostas T, Ioannou CV, Touloupakis E et al (2004) Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. Eur J Vasc Endovasc Surg 27:275–282

    PubMed  CAS  Google Scholar 

  9. Greiner M, Gilling-Smith GL (2007) Leg varices originating from the pelvis: diagnosis and treatment. Vascular 15:70–78

    Article  PubMed  Google Scholar 

  10. Kies DD, Kim HS (2012) Pelvic congestion syndrome: a review of current diagnostic and minimally invasive treatment modalities. Phlebology 27:52–57

    Article  PubMed  Google Scholar 

  11. Black CM, Thorpe K, Venbrux A et al (2010) Research reporting standards for endovascular treatment of pelvic venous insufficiency. J Vasc Interv Radiol 21(796):803

    Google Scholar 

  12. Wewers ME, Lowe NKA (1990) Critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13:227–236

    Article  PubMed  CAS  Google Scholar 

  13. Park SJ, Lim JW, Ko YT et al (2004) Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AJR Am J Roentgenol 182:683–688

    Article  PubMed  Google Scholar 

  14. Stones RW (2003) Pelvic vascular congestion-half a century later. Clin Obstet Gynecol 46:831–836

    Article  PubMed  Google Scholar 

  15. Hobbs JT (2005) Varicose veins arising from the pelvis due to ovarian vein incompetence. Int J Clin Pract 59:1195–1203

    Article  PubMed  CAS  Google Scholar 

  16. Gargiulo T, Mais V, Brokaj L et al (2003) Bilateral laparoscopic transperitoneal ligation of ovarian veins for treatment of pelvic congestion syndrome. J Am Assoc Gynecol Laparosc 10:501–504

    Article  PubMed  Google Scholar 

  17. Capasso P, Simons C, Trotteur G et al (1997) Treatment of symptomatic pelvic varices by ovarian vein embolization. Cardiovasc Intervent Radiol 20:107–111

    Article  PubMed  CAS  Google Scholar 

  18. Venbrux AC, Chang AH, Kim HS et al (2002) Pelvic congestion syndrome (pelvic venous incompetence): impact of ovarian and internal iliac vein embolotherapy on menstrual cycle and chronic pelvic pain. J Vasc Interv Radiol 13:171–178

    Article  PubMed  Google Scholar 

  19. Kim HS, Malhotra AD, Rowe PC et al (2006) Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol 17:289–297

    Article  PubMed  Google Scholar 

  20. Kwon SH, Oh JH, Ko KR et al (2007) Transcatheter ovarian vein embolization using coils for the treatment of pelvic congestion syndrome. Cardiovasc Intervent Radiol 30:655–661

    Article  PubMed  Google Scholar 

  21. Smith PC (2012) The outcome of treatment for pelvic congestion syndrome. Phlebology 27:74–77

    Article  PubMed  Google Scholar 

  22. Gloviczki P, Comerota AJ, Dalsing MC et al (2011) The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 53:2S–48S

    Article  PubMed  Google Scholar 

  23. Ratnam LA, Marsh P, Holdstock JM et al (2008) Pelvic vein embolisation in the management of varicose veins. Cardiovasc Intervent Radiol 31:1159–1164

    Article  PubMed  Google Scholar 

  24. Marsh P, Holdstock J, Harrison C et al (2009) Pelvic vein reflux in female patients with varicose veins: comparison of incidence between a specialist private vein clinic and the vascular department of a National Health Service District General Hospital. Phlebology 24:108–113

    Article  PubMed  CAS  Google Scholar 

  25. Gad MA, Saber A, Hokkam EN (2012) Assessment of causes and patterns of recurrent varicose veins after surgery. N Am J Med Sci 4:45–48

    Article  PubMed  Google Scholar 

  26. Milone M, Salvatore G, Maietta P et al (2011) Recurrent varicose veins of the lower limbs after surgery. Role of surgical technique (stripping vs. CHIVA) and surgeon’s experience. G Chir 32:460–463

    PubMed  CAS  Google Scholar 

  27. Gültaşli NZ, Kurt A, Ipek A et al (2006) The relation between pelvic varicose veins, chronic pelvic pain and lower extremity venous insufficiency in women. Diagn Interv Radiol 12:34–48

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Luis Cebrian, Radiology Department, Hospital Clínico Universitario (Zaragoza, Spain), for his help with English and Dr. Sergio Sierre, Interventional Radiology Department, Hospital Nacional de Pediatría J.P. Garrahan (Buenos Aires, Argentina) for his insightful comments and discussion

Conflict of interest

Alicia Laborda, Joaquin Medrano, Ignacio de Blas, Ignacio Urtiaga, and Francisco Cesar Carnevale have no conflict of interest or financial ties to disclose. Miguel A. de Gregorio is proctor for Cook Medical, with no conflicts of interest in this paper.

Author information

Authors and Affiliations

  1. Group of Research in Minimally Invasive Techniques Research (GITMI), University of Zaragoza, Zaragoza, Spain

    Alicia Laborda, Joaquin Medrano & Miguel A. de Gregorio

  2. Unidad de patología quirúrgica, Edificio Hospital Veterinario, 2ª planta, 50013, Zaragoza, Spain

    Alicia Laborda

  3. Interventional Radiology, Hospital Clínico Universitario “Lozano Blesa”, 50009, Zaragoza, Spain

    Joaquin Medrano & Miguel A. de Gregorio

  4. Department of Animal Pathology (Unit of Infectious Diseases and Epidemiology), University of Zaragoza, Edificio Hospital Veterinario, 2ª planta, 50013, Zaragoza, Spain

    Ignacio de Blas

  5. Department of Vascular Surgery, Hospital Clinico Universitario “Lozano Blesa”, 50009, Zaragoza, Spain

    Ignacio Urtiaga

  6. Interventional Radiology, University of Sao Paulo, Medical School, São Paulo, Brazil

    Francisco Cesar Carnevale

  7. Radiology Department, Medical School, Domingo Miral s/n. Edificio B planta baja (secretaría), 50009, Zaragoza, Spain

    Miguel A. de Gregorio

Authors
  1. Alicia Laborda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joaquin Medrano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ignacio de Blas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ignacio Urtiaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francisco Cesar Carnevale
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Miguel A. de Gregorio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miguel A. de Gregorio.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Laborda, A., Medrano, J., de Blas, I. et al. Endovascular Treatment of Pelvic Congestion Syndrome: Visual Analog Scale (VAS) Long-Term Follow-up Clinical Evaluation in 202 Patients. Cardiovasc Intervent Radiol 36, 1006–1014 (2013). https://doi.org/10.1007/s00270-013-0586-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-013-0586-2

Keywords

Search

Navigation