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Pelvic congestion syndrome

approach

Tips & tricks

Altarazi Louay M.D Damascus-Syria

Overlooked & underdiagnosed common gynecologic pathology

Pelvic venous communication anatomy is best defined

Syrian national P.C.S prevalence study 2005:

- 47% of participants (20-40 years old) complain of some clinical aspects of PCS -23% of screened women have proven pelvic varicose veins -Higher prevalence of PCS in Syrian female population than in Western countries maybe due to High number of pregnancies, marriages in the same family in Syria and to the style of life.

2006- September 2015 More than 390 case treated by endovascular techniques

mm Pelvic congestion syndrome approach, Tips & tricks

Pelvic congestion syndrome approach Tips & tricks

Indications pelvic varicosities seen in laparoscopy, ultrasounds, MRI, CT

or open surgery with : Otherwise unexplained sever PCS symptoms or Severe labial or perineal varicosities or Related lower extremities varicose veins recurrence

immediately after adequate treatment

Contraindications Iodine allergy , renal failure, asymptomatic patients

preparation Building friendship and confidence with patients Full detailed explanation of the procedure Conscious sedation-analgesic

Endovascular approach the golden standard

Pelvic congestion syndrome approach, Tips & tricks


Untreated collaterals = recurrence



Guiding and balloon catheter support



Dealing with huge incontinent veins

- transcatheter vein filling with

(Xylocain+contast agent+saline) mixture

- five minutes later lent injection of

some boiled contrast till obtaining

moderate vein spasm.

- Slow injection of foam contrast

mixture ( 2 ml of 3% sclerosing agent

“STS or Polidocanol” + 1 ml of contrast

agent + 2 ml saline + 15 ml air Tssari’s

method agitated) distally then more

and more proximally

Boiled contrast technique



4 axes cartography & treatment



Anomalies = dangerous anatomy



Annular left renal vein


Nutcracker syndrome



May –Turner syndrome



Related lower limbs varicose veins



Labial, perineal and vulval varicosities


Complications :

• variable postembolization syndrome (24-72 h)

(mild pelvic and dorsal pain, fever, nausea)

• rare hematomas, extravasations, DVT, allergy

• chest malaise is frequent but extremely rare gas embolism (pulmonary, neurologic or optical)

General results :

• 95-100% procedure success

• 50-60 % complete pain resolution

• 25-40 % pain amelioration

• More than 85% patients satisfaction

• 10-30% symptoms recurrence in tow years


• Overlooked & Underdiagnosed common Gynecologic

pathology

• Major cause of women's invalidism and

both sex postsurgical varicose veins recurrence

• Reflux Endovascular treatment is effective, noninvasive, well tolerated & repetitive

• Foam sclerotherapy is safe & non expensive

• Satisfactory results but experience dependant


Conclusion; Pelvic Congestion Syndrome is


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