Endovascular Interventions for Pelvic Congestion Syndrome - Rarely Utilized and Unremarkable Results

Pelvic congestion syndrome (PCS) can be debilitating for patients, challenging for physicians to diagnose and to treat, and frustrating for patients and providers. With minimally invasive endovascular interventions gaining favor over open interventions, we evaluate the radiographic diagnoses, clinical symptoms, and postoperative outcomes of patients receiving endovascular interventions for PCS.

Methods: A retrospective analysis of electronic medical records was performed at a multihospital, single institution. Utilizing MARS, we identified all patients with radiologic reports including key terms consistent with PCS between 2000 and 2021. Through direct review of collected radiologic reports, we identified patients with radiologic evidence of PCS (i.e., pelvic varicosities or dilated ovarian veins). Their clinical presentation, baseline demographics, relevant histories (medical, surgical, gynecologic, and social), as well as post diagnostic PCS procedures were analyzed. Postoperative outcomes were assessed.


Results: We identified 2,079 patients with radiologic evidence of PCS, of which 1.4% (n=30) underwent an intervention for PCS, with 96.7% identifying as female. At the time of first PCS treatment, patients had a mean age of 40.5 and mean BMI of 24.9. Radiologic diagnoses included pelvic varicosities (30.0%, n=9) and dilated ovarian veins (10%, n=3), as well as both pelvic varicosities and dilated ovarian veins (60%, n=18). Clinical symptoms included pelvic pain (96.7%, n=29), flank pain (33.3%, n=10), and genital varices (3.3%, n=1). These findings are summarized in table 1.


Interventions included ovarian vein coiling (86.7%, n=26), other pelvic coiling (30.0%, n=9), and iliac vein angioplasty and stenting (3.3%, n=1). The mean follow-up was 25.3 months (range of 0.3-105.9 months) with 7 patients (23.3%) reporting resolved symptoms, 4 patients (13.3%) reporting improved symptoms, and 19 patients (63.3%) reporting persistent symptoms. Of the 26 patients undergoing ovarian vein coiling, 7 had symptom resolution, 3 had symptom improvement, and 16 had symptom persistence. Additionally, 14 patients (46.7%) underwent 20 related procedures after their initial PCS intervention, including hysterectomy (n=7), oophorectomy (n=6), ovarian vein embolization (n=3), embolization of pelvic varicosities (n=3), repeat venogram (n=2), venogram with sclerotherapy (n=1), iliac vein angioplasty and stenting (n=1), and hysteroscopy (n=1). Postoperative outcomes are summarized in table 2.


Conclusions:

Endovascular interventions for PCS are uncommon and provide mixed clinical results. Given the number of postoperative gynecologic procedures, coordinated care across specialties is pertinent for treating patients with PCS.