Pelvic pain related to pelvic venous congestion often occurs in women with symptomatic lower extremity venous reflux. Treating ovarian venous incompetence with embolotherapy can not only reduce associated pelvic pain, but can also significantly reduce the pain associated with lower extremity reflux, according to Carl M. Black, M.D.
Because the disorders occur together in so many women, he recommends that women with complex nonsaphenous superficial lower extremity venous insufficiency be questioned regarding concomitant symptoms of pelvic congestion.
“These are some of the most complex varicose vein patients you will ever see,” Dr. Black of the Intermountain Vein Center, Provo, Utah, said in an interview. “It's very, very hard to make them happy and their problems tend to get worked up piecemeal and a more comprehensive approach may significantly improve their ultimate outcome.”
Symptoms of pelvic congestion syndrome are heaviness in the pelvis with standing, low abdominal pain, painful varicosities in branches around the labia and vulva, and varicosities that emerge from the gluteal region and extend into the legs.
“About 16% of the women with varicose veins will say they have pelvic pain that cycles with their leg pain—when their pelvis feels bad, their leg veins bulge more and feel worse,” Dr. Black said. “As you define it more, it is classical pelvic congestion.”
At the annual meeting of the Society of Interventional Radiology, Dr. Black presented the results of a study evaluating transcatheter embolization in patients with both disorders.
The study group consisted of 160 women with symptomatic lower extremity superficial reflux. Their mean age was about 39 years, with a mean of three pregnancies. Each patient received a thorough lower extremity venous duplex ultrasound, which included evaluation of atypical transpelvic venous reflux. Clinical and ultrasonographic findings suggested pelvic congestion syndrome in 26 (16%) of the women. All 26 had complex nonsaphenous patterns of lower extremity venous reflux.
Twenty-four of these patients then underwent venography, which confirmed ovarian venous insufficiency in 22 (94%). These 22 patients had embolotherapy on the insufficient pelvic veins. Embolization was successful in 100%.
After pelvic embolization, 19 (86%) reported relief or significant reduction in pelvic pain and 14 (63%) reported reduction of both pelvic and lower extremity pain. After subsequent comprehensive treatment of remaining identifiable sources of lower extremity venous reflux, 20 of the 22 patients (91%) reported sustained overall treatment satisfaction at follow-up with approximately 60% of patients having been followed out to between 6 and 12 months.