General Session VI - Pelvic Venous Disorders and Venous Thromboembolism
Quickshot: The Complexity of Diagnosing Pelvic Congestion Syndrome: An Insight into Symptom Diversity and Patient’s Journey to Diagnosis
Tuesday, March 5, 2024
2:31 PM – 2:37 PM EST
Location: Tampa Bay Ballroom Salons 1-4
Objective: Pelvic Congestion Syndrome (PCS) is a vascular disorder primarily observed in premenopausal women, though not exclusively. Varicose veins in the pelvis, either multifactorial or as the result of compression syndromes, cause a buildup of blood leading to pressure and pain1. While pelvic pain is the most common symptom, PCS can manifest through a plethora of nonspecific symptoms that may overlap with other pelvic conditions, making its clinical identification a challenge. The lack of standardized diagnostic criteria and varied symptomatology contribute to frequent misdiagnoses and prolonged suffering for patients.
Methods: We performed a retrospective review of the medical records of 29patients, from June 2019 to June 2023. We collated information on the duration of symptoms, initial reasons for referral, characteristics of symptoms,referral provider specialty, and prior medical or surgical interventions.
Results: Of the 29 patients, 27 female (93%), 2 male (7%), average age 42y/o, median age 41 y/o.The data reveals a diverse range of symptomatic experiences: all 29 patients reporting pelvic pain, 4 reported pelvic pain exacerbated during menstrual cycle (14%), 12 reported lower extremity symptoms (41%), 6 lower back pain (21%), and 10 with pain associated with sitting or standing (34%).Symptom durations ranged from 6 months to as long as 20 years (average 7, median 6).Of the 29 patients, 11 are referred from vascular surgery (38%), 7 self-referral (24%), 5 OBGyn (17%), 2 neurology/pain management (7%), 1 family medicine (3%), 1 urology (3%) and 1 interventional radiology (3%). Additionally, their medical histories revealed a range of previous interventions. 8 patients had a history of venous procedures, including venograms, venous stripping, and venous embolization. 5 patients with history of C-sections, and 4 had undergone hysterectomies. Other gynecological procedures include interventions like vaginectomyand endometrial ablation for endometriosis.
Conclusions: The diversity and nonspecific nature of symptoms linked to PCS, point to an urgent need for improved clinical recognition and education on this syndrome. The prolonged duration of symptoms experienced by many, often leading to multiple referrals across specialties, further emphasizes the imperative for diagnostic clarity. Strengthened multidisciplinary collaboration and increased education among healthcare professionals can facilitate swifter identification and management of PCS. By refining diagnostic pathways and fostering a more comprehensive understanding of the condition, we can ensure that patients receive appropriate, timely interventions, ultimately improvingtheir quality of life and minimizing medical costs associated with misdiagnosis and unnecessary treatments.
