Chronic pelvic pain (CPP) – recurrent or persistent abdominal or pelvic pain lasting at least 3–6 months without any identifiable pelvic pathology. This condition affects approximately 33% of women. Chronic pelvic pain can be a component of Pelvic Congestion Syndrome (PCS), which is characterised by pelvic venous insufficiency and varicose veins in the pelvic region.
DPS is present in 10-30% of patients with CDS in whom no other obvious pathology can be found
TiDPS frequency is not easy to determineas there are no standard diagnostic criteria and even no clear clinical suspicion in women with gynaecological and urological symptomsThere is no specific clinical evidence of urological and urogynaecological symptoms.
Syndromes
Large-scale surveys show that the most common comorbid syndromes alongside DPS are:
- Severe fatigue (72%)
- Dizziness (63%)
- Irritable bowel syndrome symptoms (61%)
- Brain fog (33%)
- Migraine headaches (49%)
- Polyuria with dysuria (41%)
- Heavy sweating (31%)
- Temporomandibular joint pain (31%)
- Softer skin, softer joints (18%)
Diagnostics
Ultrasound examination available at to detect pelvic varices, it can help confirm pelvic venous stasis syndrome. But for more precise other imaging tests may be needed to confirm the diagnosis. These tests may include venography, computed tomography (CT), magnetic resonance imaging (MRI) or magnetic resonance venography.
The diagnostic criteria for diagnosing pelvic venous stasis syndrome by ultrasound are:
– Tortuous pelvic veins with a diameter of > 6 mm
– Slow blood flow < 3 cm/s or reverse flow
– Dilated arcuate veins in the myometrium connecting bilateral pelvic varices.
– Polycystic changes in the ovaries
Table: PCS Patient Population
To simplify the diagnosis and treatment of DSS, the team should include an interventional radiologistwho can not only perform venography to diagnose the syndrome, but also one of the treatment options – embolization.
Treatment
Treatment of chronic pelvic pain caused by CDS with non-steroidal anti-inflammatory drugs (NSAIDs) or ovarian suppressants is often the first-line treatment until invasive treatment is available.
Ovarian embolisation is one of the best treatments, with an effectiveness rate of between 70% and 100% The aim of this treatment is to close the pelvic veins that cause venous stasis. The indications for this treatment are chronic pelvic pain lasting > 6 months, excluding other causes of pain, and marked perineal and perianal varices.
Embolization os a treatment option
Minimally invasive procedure
High clinical and treatment success rates
Performed under local anaesthesia or conscious sedation (no need for general anaesthesia)
Can often be done in an outpatient or day-hospital setting
Faster recovery compared to surgery
Reduced patient discomfort
Lower risk of complications
Cost-effective for both patients and healthcare systems
Preserves organ function and avoids major surgery
Supported by international clinical practice guidelines
Embolization of the deep pelvic veins
Venous embolization is only performed in pafter confirmation of disease by transvaginal bidirectional ultrasound. To target veins very thin catheters are inserted. After the catheter is inserted, a specialised inert platinum coil is inserted into the veinswhich closes the vein and stops reflux through the pelvic veins.
The procedure is performed in the interventional radiology department under local anaesthesia or IV sedation. Clinical studies indicate that this treatment method guarantees a high clinical success rate (70-85%) (Borghi C, Dell’Atti Pelvic congestion syndrome: the current state of the literature.. L. Arch Gynecol Obstet 2016;293:291-301)
Products
ANGIO SEAL VIP
Angio-Seal™ VIP Cruciate Vein Closure Device for closure and reduction of time to haemostasis at the site of common femoral artery puncture in patients undergoing diagnostic angiography or interventional procedures
RADIFOCUS wire
TERUMO hydrophilic guidewire, coated with polyurethane, a hydrophilic polymer coating, for guiding the catheter to the desired location in the vascular system during procedures
RADIFOCUS catheter
Angiographic or diagnostic TERUMO catheter for angiographic procedures, used with a guidewire: delivers radioactive media and materials to selected sites in the vascular system
PROGREAT
TERUMO microcatheter with integrated wire for therapeutic embolization and angiography in peripheral blood vessels. Ease of use, bend resistance, distal flexibility
