title: Pelvic congestion syndrome (pelvic venous incompetence): impact of ovarian and internal iliac vein embolotherapy on menstrual cycle and chronic pelvic pain.
abstract: OBJECTIVE
  The purpose of this study was to analyze the impact of transcatheter embolotherapy on pain perception and menstrual cycle in women with chronic pelvic pain caused by the presence of ovarian and pelvic varices (ie, women with pelvic congestion syndrome or pelvic venous incompetence).
  
  
  METHODS
  From July 1998 to August 2000, 56 patients (mean age, 32.3 y) were treated for chronic pelvic pain. Diagnostic venography of the ovarian veins was followed by transcatheter embolotherapy with a sclerosing agent and coils. A second session was completed to embolize the internal iliac veins in 43 of 56 patients. Visual analog scales (VAS) used to measure pain were administered before embolization and at 3-, 6-, and 12-month follow-up. Questionnaires regarding menstrual history were used as part of the postprocedural analysis.
  
  
  RESULTS
  Percutaneous transcatheter embolotherapy of ovarian and pelvic varices was technically successful in 56 of 56 patients (100%); three patients developed recurrent varices, two of whom were treated with repeat transcatheter embolotherapy. Two patients, early in the experience, had complications in which coils placed in the internal iliac veins embolized to the pulmonary circulation; the coils were snared without clinical sequelae. On the VAS, the mean baseline pain level was 7.8 (range, 3.2-9.8; n = 56); at 3-month follow-up, it was 4.2 (range, 0.0-7.2; n = 56); at 6 months, 3.8 (range, 0.0-6.7; n = 41); and at 12 months, 2.7 (range, 0.0-6.9; n = 32). Differences were significant (P <.001) between baseline pain levels and those at all follow-up intervals (ie, 3, 6, and 12 months). The mean decrease in VAS was 5.1 (65% decrease). The clinical follow-up in this series ranged between 6 and 38 months; the mean was 22.1 months. Regarding the impact of embolization on menstruation, all 24 patients responding to questionnaires indicated no change in menstrual cycle.
  
  
  CONCLUSIONS
  For patients with ovarian/internal iliac varices, transcatheter embolotherapy provides a nonsurgical treatment option. There is a significant decrease in pain based on VAS without any notable impact on menstrual cycle.
authors.affiliation: Interventional Radiology Division, The George Washington University, Washington, DC 20037, USA. radacv@gwumc.edu
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Venbrux
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Chang
authors.forename: Hyun S
authors.initials: HS
authors.lastname: Kim
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Montague
authors.forename: Jillyn B
authors.initials: JB
authors.lastname: Hebert
authors.forename: Aravind
authors.initials: A
authors.lastname: Arepally
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rowe
authors.forename: Diana F
authors.initials: DF
authors.lastname: Barron
authors.forename: Drew
authors.initials: D
authors.lastname: Lambert
authors.forename: J Courtland
authors.initials: JC
authors.lastname: Robinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007084:Iliac Vein; D008597:Menstrual Cycle / Q000502:physiology; D008875:Middle Aged; D010049:Ovarian Diseases / Q000150:complications / Q000628:therapy*; D010053:Ovary / Q000098:blood supply*; D010147:Pain Measurement; D017699:Pelvic Pain / Q000209:etiology / Q000628:therapy*; D010388:Pelvis / Q000098:blood supply*; D010690:Phlebography; D013577:Syndrome; D016896:Treatment Outcome; D014648:Varicose Veins / Q000628:therapy*