PELVIC CONGESTION SYNDROME - EARLY CLINICAL-RESULTS AFTER TRANSCATHETER OVARIAN VEIN EMBOLIZATION

Purpose: This case series describes the early radiographic and clinica l results of attempted transcatheter ovarian vein (OV) embolization in 11 women with symptoms that were suggestive of the pelvic congestion syndrome (PCS). Methods: Eleven women (mean age, 33.1 years) who mere multiparous were referred for lower extremity or vulvar varicosities ( n = 8) or for tube-ovarian varicosities (n = 3). After a clinical diag nosis of PCS was established, the women underwent ovarian (n = 5) or o varian and iliac vein (n = 6) venography. Enlarged or incompetent OVs were embolized with 0.035-inch stainless steel coils or with 0.018-inc h platinum microcoils and absorbable gelatin sponge. Incompetent tribu taries to hypogastric veins were embolized as well (n = 1). Symptoms b efore embolization and after embolization were recorded with a standar d questionnaire, and the post-embolization symptoms were expressed as individual and overall percent relief. Results: Nine of the 11 women u nderwent embolization. Embolization of both OVs (n = 4), of the left O V alone (n = 4), or of a left obturator vein that communicated with vu lvar varices (n = 1) was performed. Eight of the 9 women (88.9%) had m ore than 80% immediate relief. Overall and individual symptom relief v aried from 40% to 100% at the mean 13.4-month follow-up. One woman wit h variant anatomy and one woman with evidence of prior left OV thrombo sis were not treated. There were no major complications. Two women had a mild to moderate return of the symptoms at 6 and 22 months. Conclus ions: Transcatheter embolization provides excellent initial and variab le midterm relief in women with typical PCS symptoms and with OV or OV and internal iliac (hypogastric) tributary vein incompetence. This in terventional technique may replace or complement the traditional surgi cal approaches to this rarely recognized and poorly understood disease .