Role of Trans-catheter Ovarian Vein EmbolizationIn The Management of Symptomatic Chronic Pelvic Congestion In Females

Abstract

Chronic pelvic pain (CPP) is assumed to affect approximately 30% of all females in child bearing period and it accounts for almost 20% of outpatient gynecological appointments. The diagnosis and management of PCS continue to evolve. PCS remains an underdiagnosed cause of chronic pelvic pain because of the difficulty in identifying varicosities and ovarian vein reflux in patients who are supine. The symptoms of PCS are often lifestyle limiting, consisting of chronic lower abdominal pain exacerbated by sitting or standing, dyspareunia, dysuria, vulvar and lower extremity varicosities, and pelvic tenderness.Nutcracker syndrome can also be manifested with hematuria and flank pain. Vascular surgeons in academic and community settings can improve the diagnosis of PCS by educating primary care physicians through in service or continuing education seminars on the signs and symptoms of PCS. Because PCS is frequently a diagnosis of exclusion, an awareness of its prevalence within the primary care patient population can ultimately increase the referral of appropriate patients to vascular specialists for further workup. Diagnosis of PCS requires a careful history, physical examination, and noninvasive imaging with either transvaginal or transabdominal US with color duplex imaging to visualize dilated and tortuous ovarian veins.MDCT with three dimensional