Pelvic congestion syndrome: historical aspects and a modern view on the problem (a literature review)
DOI:
https://doi.org/10.14739/2310-1210.2021.5.224621Keywords:
pelvic congestion syndrome, varicose veins, pelvic venous disorders, pelvic varicocele, pelvic venous stasis, pelvic pain, gonadal veins, ovarian veins, Nutcracker syndrome, May–Thurner syndromeAbstract
Pelvic congestion syndrome is a relatively recent, but actual and separate nosological form. Pelvic varicocele is a form of varicose disease, which is increasingly regarded as the main cause of chronic pelvic pain in women with various clinical manifestations. A woman with chronic pelvic pain is a difficult patient with combative behavior, who contacts with physicians in various specialties. There are many causes of chronic pelvic pain, but pelvic congestion syndrome has a special place. In recent years, in addition to widespread use of diagnostic radiology, the relevance of this pathology is beyond any doubt.
The aim of the study was to summarize and present literature data on the etiology, pathogenesis, clinical manifestations, diagnosis and treatment of pelvic congestion syndrome by analyzing the literature data.
Materials and methods. A non-systematic review was conducted using PubMed, Web of Science, Google and Google Scholar databases. The review included free full-text articles published between 1974 and 2021 using key words: pelvic congestion syndrome, pelvic varices, pelvic venous disorders, pelvic varicocele, pelvic venous stasis, chronic pelvic pain, gonadal veins, ovarian veins, vena ovarica, Nutcracker syndrome, May–Thurner syndrome.
Conclusions. Pelvic congestion syndrome is still a rarely diagnosed pathology in patients with chronic pelvic pain. Detailed medical history, physical examination as well as maintaining diagnostic algorithm would allow the disease to be diagnosed correctly and timely. The choice of method for surgical intervention is a key point in the treatment of patients with pelvic congestion syndrome, but today there are no criteria for the choice of one, so the problem is far from being resolved and requires further study and research.
References
- Daniels, J., Gray, R., Hills, R. K., Latthe, P., Buckley, L., Gupta, J., Selman, T., Adey, E., Xiong, T., Champaneria, R., Lilford, R., Khan, K. S., & LUNA Trial Collaboration. (2009). Laparoscopic Uterosacral Nerve Ablation for Alleviating Chronic Pelvic Pain: A Randomized Controlled Trial. JAMA, 302(9), 955-961. https://doi.org/10.1001/jama.2009.1268
- Ushakova, G. A., Mozes, V. G., Rozenberg, B. A., Mironov, S. B., & Timonin, O. Yu. (2001). Varikoznoe rasshirenie ven malogo taza u zhenshchin [Varicose veins of the small pelvis in women]. Mat' i ditya v Kuzbase, (5-6), 28-33. [in Russian].
- Koo, S., & Fan, C. M. (2014). Pelvic Congestion Syndrome and Pelvic Varicosities. Techniques in Vascular and Interventional Radiology, 17(2), 90-95. https://doi.org/10.1053/j.tvir.2014.02.005
- Daniels, J. P., & Khan, K. S. (2010). Chronic Pelvic Pain in Women. BMJ, 341(7776), Article c4834. https://doi.org/10.1136/bmj.c4834
- Liddle, A. D., & Davies, A. H. (2007). Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices. Phlebology, 22(3), 100-104. https://doi.org/10.1258/026835507780807248
- Hobbs, J. T. (1990). The pelvic congestion syndrome. British Journal of Hospital Medicine, 43(3), 200-206.
- Craig, O., & Hobbs, J. T. (1975). Vulval phlebography in the pelvic congestion syndrome. Clinical Radiology, 26, 517-525. https://doi.org/10.1016/s0009-9260(75)80112-7
- Sushkov, S. A. (2016). Varikoznaya bolezn' taza [Varicose pelvis vein disease]. Meditsinskie novosti, (12), 4-12. [in Russian].
- Antignani, P. L., Lazarashvili, Z., Monedero, J. L., Ezpeleta, S. Z., Whiteley, M. S., Khilnani, N. M., Meissner, M. H., Wittens, C. H., Kurstjens, R. L., Belova, L., Bokuchava, M., Elkashishi, W. T., Jeanneret-Gris, C., Geroulakos, G., Gianesini, S., de Graaf, R., Krzanowski, M., Al Tarazi, L., Tessari, L., & Wikkeling, M. (2019). Diagnosis and treatment of pelvic congestion syndrome: UIP consensus document. International Angiology, 38(4), 265-283. https://doi.org/10.23736/S0392-9590.19.04237-8
- Perry, C. P. (2001). Current Concepts of Pelvic Congestion and Chronic Pelvic Pain. Journal of the Society of Laparoendoscopic Surgeons, 5(2), 105-110.
- Corrêa, M. P., Bianchini, L., Saleh, J. N., Noel, R. S., & Bajerski, J. C. (2019). Síndrome da congestão pélvica e embolização de varizes pélvicas. Jornal Vascular Brasileiro, 18, Article e20190061. https://doi.org/10.1590/1677-5449.190061
- Champaneria, R., Shah, L., Moss, J., Gupta, J. K., Birch, J., Middleton, L. J., & Daniels, J. P. (2016). The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness. Health Technology Assessment, 20(5), 1-108. https://doi.org/10.3310/hta20050
- Dorobisz, T. A., Garcarek, J. S., Kurcz, J., Korta, K., Dorobisz, A. T., Podgórski, P., Skóra, J., & Szyber, P. (2017). Diagnosis and treatment of pelvic congestion syndrome: single-centre experiences. Advances in Clinical and Experimental Medicine, 26(2), 269-276. https://doi.org/10.17219/acem/68158
- Sokolov, A. A. (n.d.). Varikoznaya bolezn' ven malogo taza [Varicose disease of small pelvic veins]. http://ultrasound.net.ua/materiali/organi-ta-sistemi/ginekologija/varikoznaja-bolezn-ven-malogo-taza/ [in Russian].
- Jurga-Karwacka, A., Karwacki, G. M., Schoetzau, A., Zech, C. J., Heinzelmann-Schwarz, V., & Schwab, F. D. (2019). A forgotten disease: Pelvic congestion syndrome as a cause of chronic lower abdominal pain. PLOS ONE, 14(4), Article e0213834. https://doi.org/10.1371/journal.pone.0213834
- Brown, C. L., Rizer, M., Alexander, R., Sharpe, E. E., 3rd, & Rochon, P. J. (2018). Pelvic Congestion Syndrome: Systematic Review of Treatment Success. Seminars in Interventional Radiology, 35(1), 35-40. https://doi.org/10.1055/s-0038-1636519
- Maiorov, M. V. (2006). Varikoznaya bolezn' ven malogo taza u zhenshchin [Varicose disease of small pelvic veins in women]. Provisor, (16), 36-38. [in Russian].
- Beard, R. W., Reginald, P., & Pearce, S. (1987). Pelvic pain in women. British Medical Journal, 294(6564), 124. https://doi.org/10.1136/bmj.294.6564.124-a
- Kies, D. D., & Kim, H. S. (2012). Pelvic Congestion Syndrome: A Review of Current Diagnostic and Minimally Invasive Treatment Modalities. Phlebology, 27(Suppl. 1), 52-57. https://doi.org/10.1258/phleb.2012.012s27
- Tu, F. F., Hahn, D., & Steege, J. F. (2010). Pelvic Congestion Syndrome-Associated Pelvic Pain: A Systematic Review of Diagnosis and Management. Obstetrical & Gynecological Survey, 65(5), 332-340. https://doi.org/10.1097/OGX.0b013e3181e0976f
- Gloviczki, P., Comerota, A. J., Dalsing, M. C., Eklof, B. G., Gillespie, D. L., Gloviczki, M. L., Lohr, J. M., McLafferty, R. B., Meissner, M. H., Murad, M. H., Padberg, F. T., Pappas, P. J., Passman, M. A., Raffetto, J. D., Vasquez, M. A., Wakefield, T. W., Society for Vascular Surgery, & American Venous Forum. (2011). 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. Journal of Vascular Surgery, 53(Suppl. 5), 2S-48S. https://doi.org/10.1016/j.jvs.2011.01.079
- Sharma, K., Bora, M. K., Varghese, J., Malik, G., & Kuruvilla, R. (2014). Role of Trans Vaginal Ultrasound and Doppler in Diagnosis of Pelvic Congestion Syndrome. Journal of Clinical and Diagnostic Research, 8(7), OD05-OD7. https://doi.org/10.7860/JCDR/2014/8106.4570
- Park, S. J., Lim, J. W., Ko, Y. T., Lee, D. H., Yoon, Y., Oh, J. H., Lee, H. K., & Huh, C. Y. (2004). Diagnosis of Pelvic Congestion Syndrome Using Transabdominal and Transvaginal Sonography. American Journal of Roentgenology, 182(3), 683-688. https://doi.org/10.2214/ajr.182.3.1820683
- Arnoldussen, C. W., de Wolf, M. A., & Wittens, C. H. (2015). Diagnostic imaging of pelvic congestive syndrome. Phlebology, 30(Suppl. 1), 67-72. https://doi.org/10.1177/0268355514568063
- Bookwalter, C. A., VanBuren, W. M., Neisen, M. J., & Bjarnason, H. (2019). Imaging Appearance and Nonsurgical Management of Pelvic Venous Congestion Syndrome. RadioGraphics, 39(2), 596-608. https://doi.org/10.1148/rg.2019180159
- Borghi, C., & Dell'Atti, L. (2016). Pelvic congestion syndrome: the current state of the literature. Archives of Gynecology and Obstetrics, 293(2), 291-301. https://doi.org/10.1007/s00404-015-3895-7
- Antignani, P. L., Lazarashvili, Z., Monedero, J. L., Ezpeleta, S. Z., Whiteley, M. S., Khilnani, N. M., Meissner, M. H., Wittens, C. H., Kurstjens, R. L., Belova, L., Bokuchava, M., Elkashishi, W. T., Jeanneret-Gris, C., Geroulakos, G., Gianesini, S., de Graaf, R., Krzanowski, M., Al Tarazi, L., Tessari, L., & Wikkeling, M. (2019). Diagnosis and treatment of pelvic congestion syndrome: UIP consensus document. International Angiology, 38(4), 265-283. https://doi.org/10.23736/S0392-9590.19.04237-8
- Beard, R. W., Highman, J. H., Pearce, S., & Reginald, P. W. (1984). Diagnosis of pelvic varicosities in women with chronic pelvic pain. The Lancet, 324(8409), 946-949. https://doi.org/10.1016/s0140-6736(84)91165-6
- Wozniak, S. (2016). Chronic pelvic pain. Annals of Agricultural and Environmental Medicine, 23(2), 223-226. https://doi.org/10.5604/12321966.1203880
- Smith, P. C. (2012). The Outcome of Treatment for Pelvic Congestion Syndrome. Phlebology, 27(Suppl. 1), 74-77. https://doi.org/10.1258/phleb.2011.012s01
- Venbrux, A. C., Chang, A. H., Kim, H. S., Montague, B. J., Hebert, J. B., Arepally, A., Rowe, P. C., Barron, D. F., Lambert, D., & Robinson, J. C. (2002). Pelvic Congestion Syndrome (Pelvic Venous Incompetence): Impact of Ovarian and Internal Iliac Vein Embolotherapy on Menstrual Cycle and Chronic Pelvic Pain. Journal of Vascular and Interventional Radiology, 13(2, Pt. 1), 171-178. https://doi.org/10.1016/s1051-0443(07)61935-6
- Simsek, M., Burak, F., & Taskin, O. (2007). Effects of micronized purified flavonoid fraction (Daflon) on pelvic pain in women with laparoscopically diagnosed pelvic Ccngestion syndrome: a randomized crossover trial. Clinical and Experimental Obstetrics & Gynecology, 34(2), 96-98.
- Cheong, Y. C., Smotra, G., & Williams, A. C. (2014). Non-surgical interventions for the management of chronic pelvic pain. Cochrane Database of Systematic Reviews, (3), Article CD008797. https://doi.org/10.1002/14651858.CD008797.pub2
- Nicholson, T., & Basile, A. (2006). Pelvic Congestion Syndrome, Who Should We Treat and How? Techniques in Vascular and Interventional Radiology, 9(1), 19-23. https://doi.org/10.1053/j.tvir.2006.08.005
- Kirienko, A. I., Gavrilov, S. G., Yanina, A. M., & Turishcheva, O. O. (2016). Otsenka effektivnosti khirurgicheskikh sposobov lecheniya tazovogo venoznogo polnokroviya [Results of Different Types of Operations in Patients with Pelvic Congestion Syndrome]. Flebologiya, 10(1), 44-49. https://doi.org/10.17116/flebo201610144-49 [in Russian].
- Gavrilov, S. G., Sazhin, A., Krasavin, G., Moskalenko, E., & Mishakina, N. (2021). Comparative analysis of the efficacy and safety of endovascular and endoscopic interventions on the gonadal veins in the treatment of pelvic congestion syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 9(1), 178-186. https://doi.org/10.1016/j.jvsv.2020.05.013
- Bittles, M. A., & Hoffer, E. K. (2008). Gonadal Vein Embolization: Treatment of Varicocele and Pelvic Congestion Syndrome. Seminars in Interventional Radiology, 25(3), 261-270. https://doi.org/10.1055/s-0028-1085927
- Gavrilov, S. G., Krasavin, G. V., Mishakina, N. Y., & Kirsanov, K. V. (2020). Postembolization syndrome in endovascular interventions on the gonadal veins. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 9(3), 697-702. https://doi.org/10.1016/j.jvsv.2020.09.003
- Avgerinos, E. D., Saadeddin, Z., Humar, R., Salem, K., Singh, M., Hager, E., Makaroun, M., & Chaer, R. A. (2019). Outcomes of left renal vein stenting in patients with nutcracker syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 7(6), 853-859. https://doi.org/10.1016/j.jvsv.2019.06.016
- Khan, T. A., Rudolph, K. P., Huber, T. S., & Fatima, J. (2019). May-Thurner syndrome presenting as pelvic congestion syndrome and vulvar varicosities in a nonpregnant adolescent. Journal of Vascular Surgery Cases, Innovations and Techniques, 5(3), 252-254. https://doi.org/10.1016/j.jvscit.2019.02.008
- Wu, Z., Zheng, X., He, Y., Fang, X., Li, D., Tian, L., & Zhang, H. (2016). Stent migration after endovascular stenting in patients with nutcracker syndrome. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 4(2), 193-199. https://doi.org/10.1016/j.jvsv.2015.10.005
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