Although there are many reports about Pelvic Congestion pre-2000, the research and understanding of Pelvic Congestion Syndrome (PCS) has been rapidly evolving over the last 2 decades.
It is notable that the majority of the research into pelvic congestion has been performed by those with an interest in venous disease – venous and vascular surgeons, interventional radiologists and vascular ultrasound specialists – rather than gynaecologists or other specialists that deal with the end results of specific patterns of pelvic congestion – such as pelvic pain, haemorrhoids and varicoceles.
This emphasis on the underlying venous pathophysiology explains the recent push to change the name from PCS to Pelvic Venous Disorders (PeVD). The whole landscape of PCS has changed over the last 2 decades as our understanding has improved.
Whereas traditionally PCS has been thought to occur in females who are parous and fertile, we
now know that 25% of women with PCS are post-menopausal and 10% are nulliparous.
Moreover, it has also become clear that men suffer from PCS as well. Not only do men get varicoceles and haemorrhoids which are clearly varicose veins arising from the pel
vic veins, but in addition, pelvic pain, prostatitis and erectile dysfunction are all thought to be a result of PCS in some patients.
With respect to pathophysiology, there is a wide disparity of views as to the relative proportions of patient with obstruction as the underlying cause of the dilated pelvic veins, compared to those with reflux alone.
Although there might be some difference in different populations being served, increasingly it appears that obstruction is overestimated by non-functional imaging tests.
As such, static cross-sectional imaging is of limited value in assessing PCS.
Although venography has some benefits, it also has draw back as veins without contrast in them are not imaged and the contrast is non-physiological. As in leg veins, the optimal investigation is duplex ultrasound. Pathophysiological reflux can be seen when the
patient is in a 45 decree reverse Trendelenburg position, and most easily seen transvaginally (Holdstock-Harrison Protocol).
Although medical treatments have been reported, the mainstay of treatment for pelvic vein reflux is embolisation with coils, plugs, foam sclerotherapy or glue and for obstruction, stenting.
Pelvic Congestion Syndrome and Venous Disorder
