Successful Treatment of Pelvic Congestion Syndrome with Plug Embolization of Pelvic Incompetent Veins: 7 Cases Report

Abstract

We report seven cases of pelvic congestion syndrome (PCS) successfully treated with plug embolization of pelvic incompetent veins. All cases were PCS comorbid in patients with varicose veins of the lower extremities. The mean age was 64.1 years, and all patients had a delivery history and were postmenopausal. The symptoms of pelvic congestion worsened with prolonged standing. In all cases, the arterial phase of contrast-enhanced CT showed left ovarian veins dilated to more than 8 mm in diameter and associated pelvic varicose veins, indicating that dysfunction of the left ovarian vein was the main cause of PCS. In 4 of 7cases, selective venography in the upright position also showed dysfunction of the right ovarian vein and internal iliac vein. The incompetent veins were embolized with an average of 3.3 plugs per patient, and with plugs averaging 1.22 times the diameter of the target vein. The only complication was intraoperative venous injury in one case, and the bleeding stopped immediately after plug placement. There was no migration or deviation of the plug. The symptoms of pelvic congestion improved within one week after surgery in all patients, and no recurrence of pelvic varicose veins or symptoms has been observed for more than three years after surgery. Plug embolization is safe and effective endovascular treatment for pelvic congestion syndrome.