Embolization in Pelvic Congestion Syndrome
Pelvic congestion syndrome remains a poorly understood entity whose existence, let alone appropriate methods of investigation and treatment, are still under legitimate question. It is important that any endovascular therapist contemplating ovarian vein embolization works closely with a gynecologist, not only to ensure that other causes of pelvic pain are excluded, but to share in the considerable post procedure needs of these patients. Pelvic congestion syndrome is increasingly being diagnosed both clinically and by imaging in patients with pelvic pain. Referral patterns are changing to include women being screened for lower extremity venous insufficiency. Although there is a striking consistency to the clinical improvement achieved by ovarian vein embolization by multiple authors, it is necessary that any physician undertaking this procedure convey the controversial nature of the syndrome to the patient. Improvement in pain symptoms should be expected in 80–90 % of patients with significant improvement in 60 %. Treatment appears durable at 5-year follow-up. There remains considerable variation in the endovascular approach, and the optimum approach remains to be proven.