BUFFALO VASCULAR CARE

PELVIC VENOUS CONGESTION

The Symptoms

Vascular Interventional Associates

The symptoms of pelvic venous congestion may include:

Your OptionsPelvic venous congestion can be treated with drugs, surgery, or other procedures.Because drugs and invasive surgeries pose risks and limitations, less invasive  procedures are now recommended.

Pelvic venous congestion refers to pain that is localized to the pelvic area that is not limited to periods of the menstrual cycle, intercourse, or pregnancy. Chronic pelvic pain occurs in up to 24% of women between the ages of 18 and 50, and though it accounts for up to 1 out of 5 gynecology consults, fewer than half of those suffering from it are referred to a specialist.  Pelvic imaging can help to identify clinical patterns of varicosities consistent with pelvic venous congestion. Once a diagnosis is confirmed, embolization is a safe and highly effective intervention. Studies on embolization have reported up to 100% clinical success rates. Researchers and physicians agree that ovarian vein embolization is the best currently available treatment for pelvic congestion syndrome. This procedure is associated with far fewer complications than other options. Discomfort associated with the procedure tends to be easily managed, and complications are reported in less than 9% of patients.

Hysterectomy and bilateal salpingo- oophorectomy are major surgeries that aim to ligate or excise the ovarian veins to cutoff the potential source of pain. These surgeries are invasive and do not always provide patients with relief. In addition, they areonly an option for women who have finished their childbearing and are associated with complications. Less invasive procedures like ovarian vein embolization can be performed under local anesthesia in an outpatient setting and have been shown to have high success rates and minimal complications.

Reliable Treatment

Dr. Azher Iqbal, specializes in image guided treatments. He is Assistant Clinical Professor of Radiology at SUNY Buffalo, Medical

Director of Buffalo Vascular Care, and a Diplomat of the American Board of Radiology. He has been performing embolization for almost 20 years. Dr. Azher Iqbal is a Castle Connolly Top Doctor. He consistently receives positive reviews from his patients, who also enjoy the convenience of the office location in Lancaster, NY.

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| 6337 Transit Road | Depew, NY 14043 |716-852-1977 |www.buffalovascularcare.com

Azher Iqbal, MD  Medical Director

Non-Surgical Procedure

Invasive Surgery

References

Drug Therapy

There are several drugs that can be used to combat pelvic venous congestion. Some of these drugs are oral hormonal contraceptives and non-steroidal drugs that fight inflammation.  Unfortunately, because of the side effects associated with drugs for pelvic venous congestion, they often do not work as a long- term solution.

Varicose veins in the pelvic regionDyspareunia

Non-cyclical pelvic pain, which is often a dull, chronic pain that gets worse when standing

1. Gandini R, Chiocchi M, Konda D, Pampana E, Fabiano S, Simonetti G. Transcatheter foam sclerotherapy of symptomatic female varicocele with sodium-tetradecyl-sulfate foam. Cardiovasc Intervent Radiol. 2008;31(4):778-784. doi:10.1007/s00270-007-9264-6 2. Borghi C, Dell’Atti L. Pelvic congestion syndrome: the current state of the literature. Arch Gynecol Obstet. 2016;293(2):291-301. doi:10.1007/s00404-015-3895-7 3. Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases:  clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Suppl):2S-48S. doi:10.1016/j.jvs.2011.01.079 4. Gandini R, Konda D, Abrignani S, et al. Treatment of symptomatic high-flow female varicoceles with stop-flow foam sclerotherapy. Cardiovasc Intervent Radiol. 2014;37(5):1259-1267. doi:10.1007/s00270-013-0760-6 5. Venbrux AC, Chang AH, Kim HS, et al. Pelvic congestion syndrome (pelvic venous incompetence): impact of ovarian and internal iliac vein embolotherapy on menstrual cycle and chronic pelvic pain. J Vasc Interv Radiol. 2002;13(2 Pt 1):171-178. 6. Laborda A, Medrano J, de Blas I, Urtiaga I, Carnevale FC, de Gregorio MA. Endovascular treatment of pelvic congestion syndrome: visual analog scale (VAS) long-term follow-up clinical evaluation in 202 patients. Cardiovasc Intervent Radiol. 2013;36(4):1006-1014. doi:10.1007/s00270-013-0586-2 7. Kim HS, Malhotra AD, Rowe PC, Lee JM, Venbrux AC. Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol. 2006;17(2 Pt 1):289-297. doi:10.1097/01.RVI.0000194870.11980.F8 8. Dorobisz TA, Garcarek JS, Kurcz J, et al. Diagnosis and treatment of pelvic congestion syndrome: Single-centre experiences. Adv Clin Exp Med. 2017;26(2):269-276. doi:10.17219/acem/68158 9. Phillips D, Deipolyi AR, Hesketh RL, Midia M, Oklu R. Pelvic congestion syndrome: etiology of pain, diagnosis, and clinical management. J Vasc Interv Radiol. 2014;25(5):725-733. doi:10.1016/j.jvir.2014.01.030

Buffalo Vascular Care

A disorder of pelvic venous circulation that causes pelvic pain in women  

left ovarian vein dilatation with reflux

pelvic varices