Combination of May-Thurner syndrome and pelvic congestion syndrome: terra incognita

Sergey Gennadievich GAVRILOV, MD, PhD Professor of Surgery, Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Russia Abstract This review presents up-to-date data on the pathophysiology, epidemiology, classification, diagnosis, and treatment of the combination of May-Thurner syndrome (MTS) and pelvic congestion syndrome (PCS). It includes hypotheses to explain the predominant lesion of the pelvic veins in these patients and describes in detail the clinical symptoms of combined lesions of the iliac and pelvic veins. The article discusses modern methods of diagnosis of MTS and PCS, as well as advantages and disadvantages of ultrasound and radiological methods of investigation….

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Clinical aspects of pelvic congestion syndrome

Pier Luigi ANTIGNANI1; George GEROULAKOS2; Mamuka BOKUCHAVA3 1 Director, Vascular Center, Nuova Villa Claudia, Rome, Italy 2 Consultant Vascular Surgeon, Department of Surgery, Charing Cross Hospital, London, UK 3 Deputy Director of the Center of Vascular and Heart Diseases, Tbilisi, Georgia Abstract The main symptom of pelvic congestion syndrome (PCS) is pelvic pain. Women typically have a dull, throbbing, and achy pain in the vulvar region, which often worsens during or after intercourse, just before the onset of menstruation, and as the day progresses, especially in women who stand or sit for long periods. The cause of PCS is unknown;…

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Instrumental diagnosis of pelvic congestion syndrome

Santiago ZUBICOA EZPELETA1; Javier LEAL MONEDERO1; Assila T. ELKASHISHI2 1 Ruber Internacional Hospital, Angiology and Vascular Surgery Unit, Madrid, Spain 2 Al Salam Hospital, Cairo, Egypt Abstract Pelvic congestion syndrome (PCS) is a multifactorial medical condition that is characterized by the absence of specific symptoms, and therefore, it needs very precise imaging for an accurate diagnosis. Diagnostic techniques can be noninvasive (duplex ultrasound) or minimally invasive (magnetic resonance, CT, and phlebography). Duplex ultrasound is regarded as a first-line investigation for PCS because it is noninvasive, easily accessible, and inexpensive. This procedure provides essential hemodynamic information, and when combining transvaginal and…

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Treatment options for pelvic congestion syndrome

Javier LEAL MONEDERO1; Santiago ZUBICOA EZPELETA1; Neil M. KHILNAN2 1 Ruber Internacional Hospital, Angiology and Vascular Surgery Unit, Madrid, Spain 2 Division of Interventional Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA Abstract Pelvic congestion syndrome (PCS) and its main symptom, chronic pelvic pain, are caused by an increase in pressure, number, and caliber of intrapelvic venous structures. These structures are veins with a varicose morphology (ie, tortuous and ectatic with a very retarded flow) that are typically caused by inverted flow in the valveless and enlarged gonadal axis and, in some cases, the branches…

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Pelvic congestion syndrome: does one name fit all?

Sergio GIANESINI1; Pier Luigi ANTIGNANI2; Lorenzo TESSARI1 1 Glauco Bassi Foundation, Trieste, Italy 2 Director, Vascular center, Nuova Villa Claudia, Rome, Italy Abstract The pelvic congestion syndrome definition includes two not so frequently overlapping scenarios: (i) pelvic venous engorgement with lower abdomen symptomatology; and (ii) lower limb varicose veins fed by pelvic escape points that are generally less prone to develop the abdominal clinical manifestation typical for pelvic congestion syndrome. We retrospectively evaluated 985 female patients (43±11 years old; 23±5kg/m2 BMI) who visited our offices for lower limb varicose veins of pelvic origin. Second-level imaging was needed for 229 patients….

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Pelvic congestion syndrome: prevalence and quality of life

Zaza LAZARASHVILI1; Pier Luigi ANTIGNANI2; Javier LEAL MONEDERO3 1 Chapidze Emergency Cardiovascular Center, Liubljana str.4, 0159 Tbilisi, Georgia 2 Director, Vascular center, Nuova Villa Claudia, Rome, Italy 3 Ruber International Hospital, Angiology and Vascular Surgery Unit, La Masó St. 38, 28034, Madrid, Spain Abstract Pelvic congestion syndrome is an important cause of chronic pelvic pain that develops due to pelvic, but particularly ovarian, vein incompetence. Pelvic pain is one of the frequent reasons for outpatient gynecologic visits. Unfortunately, large and reliable studies on the prevalence of pelvic congestion syndrome do not yet exist; therefore, only indirect data, such as the…

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Treatment of vulvar and perineal varicose veins

Jean-François VAN CLEEF Service de médecine vasculaire, Institut Arthur Vernes, 36 rue d’Assas, 75006 Paris, France. Private practice: 43 rue de la Chaussée d’Antin, 75009, Paris, France SUMMARY Vulvar varicose veins occur in 10% of pregnant women, generally during month 5 of a second pregnancy. Anatomically, the vulvar veins have communicating branches and anastomoses between the pelvic wall and the veins of internal organs, between the internal and external iliac venous system, and with the circulation of the medial aspect of the thigh via the perineal veins. Vulvar varices are not caused by an increase in circulatory volume during pregnancy,…

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Chronic pelvic pain associated with pelvic congestion syndrome and the benefit of Daflon 500 mg: a review*

Feza BURAK1 Tonguc GUNDUZ2 Mehmet SIMSEK2 Omur TASKIN1,2 Departments of Obstetrics and Gynecology Ìnonu University 1, Malatya and Akdeniz University 2, Antalya School of Medicine * This review is based on the following publication: 1) Taskin O, Uryan I I, Buhur A, et al. The Effects of Daflon on Pelvic Pain in Women with Taylor Syndrome. J Am Assoc Gynecol Laparosc. 1996;3(4, Supplement):S49, and 2) Simsek M, Burak F, Taskin O. Effects of micronized purified flavonoid fraction (Daflon) on pelvic pain in women with laparoscopically diagnosed pelvic congestion syndrome: a randomized crossover trial. Clin Exp Obstet Gynecol. 2007;34(2):96-98. SUMMARY Chronic…

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Pelviperineal venous insufficiency and varicose veins of the lower limbs

Edgar BALIAN, Jean-Louis LASRY, Gérard COPPÉ, Hervé BORIE, Agnès LEROUX, Dominique BRYON, Stéphane KOVARSKY Private Hospital, Antony, France. Dept. of Cardiology and Interventional Radiology Investigation and treatment of pelvic venous insufficiency (PVI) in women to date has primarily involved its most familiar clinical presentation, ie, pelvic congestion syndrome (PCS) accurately described by Hobbs.1 For the last few years,2 more attention has focused on involvement of PVI in the pathogenesis of primary varicose veins or recurring varicosities of the lower limbs. This finding has been confirmed by a national epidemiologic survey that evaluated the potential incidence of pelvic pain of venous…

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The relation between pelvic varicose veins, chronic pelvic pain, and lower extremity venous insufficiency in women

Neslihan ZEHRA GÜLTAPLÝ, Aydýn KURT, Ali ÝPEK, Mehmet GÜMÜP, Kemal Rýdvan YAZÝCÝOPLU, Gülçin DILMEN, Ýsmet TAP SUMMARY Purpose: to determine the frequency of pelvic varicose veins with transvaginal ultrasound and associated lower extremity venous insufficiency with Doppler ultrasound in women with chronic pelvic pain of undetermined origin. A total of 100 women with chronic pelvic pain of undetermined origin lasting more than 6 months were included in the study. The presence of anechogenic and non-pulsatile vascular structures demonstrating flow in Doppler ultrasound with a diameter >5 mm in parauterine and paraovarian localizations was accepted as pelvic varicose veins. In all…

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