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Diagnosis
and Assessment
Once other abnormalities or
inflammation has been ruled out by a thorough pelvic exam, pelvic
congestion syndrome can be diagnosed through several minimally
invasive methods. An interventional radiologist, a doctor
specially trained in performing minimally invasive treatments
using imaging for guidance, will use the following imaging
techniques to confirm pelvic varicose veins that could be causing
chronic pain.
Pelvic venography: Thought to be the most accurate
method for diagnosis, a venogram is performed by injecting
contract dye in the veins of the pelvic organs to make them
visible during an X-ray. To help accuracy of diagnosis,
interventional radiologists examine patients on an incline,
because the veins decrease in size when a woman is lying flat.
MRI: May be the best non-invasive way of diagnosing
pelvic congestion syndrome. The exam needs to be done in a way
that is specifically adapted for looking at the pelvic blood
vessels. A standard MRI may not show the abnormality.
Pelvic ultrasound: Usually not very helpful in
diagnosing pelvic congestion syndrome unless done is an very
specific manner with the patient standing while the study is being
done. Ultrasound may be used to exclude other problems that might
be causing pelvic pain.
Transvaginal ultrasound: This technique is used to
see better inside the pelvic cavity. As with a pelvic ultrasound
it is not very good at visualizing the pelvic veins unless the
woman is standing. However it may be used to exclude other
problems.
Treatment
Once a diagnosis is made, if the
patient is symptomatic, an embolization should be done.
Embolization is a minimally invasive procedure performed by
interventional radiologists using imaging for guidance. During the
outpatient procedure, the interventional radiologist inserts a
thin catheter, about the size of a strand of spaghetti, into the
femoral vein in the groin and guides it to the affected vein using
X-ray guidance. To seal the faulty, enlarged vein and relieve
painful pressure, an interventional radiologist inserts tiny coils
often with a sclerosing agent (the same type of material used to
treat varicose veins) to close the vein. After treatment, patients
can return to normal activities immediately.
Additional treatments are available depending on the
severity of the woman's symptoms. Analgesics may be prescribed to
reduce the pain. Hormones such birth control pills decrease a
woman's hormone level causing menstruation to stop may be helpful
in controlling her symptoms. Surgical options include a
hysterectomy with removal of ovaries, and tying off or removing
the veins.
In addition to being less expensive to surgery and much
less invasive, embolization offers a safe, effective, minimally
invasive treatment option that restores patients to normal. The
procedure is very commonly successful in blocking the abnormal
blood flow. It is successfully performed in 95-100 percent of
cases. A large percentage of women have improvement in their
symptoms, between 85-95 percent of women are improved after the
procedure. Although women are usually improved, the veins are
never normal and in some cases other pelvic veins are also
affected which may require further treatment.
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