pelvic congestion syndrome approach tips & tricks …venous.in/presentationtalk/dr. louay al...
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Overlooked & underdiagnosed common gynecologic pathology
Pelvic venous communication anatomy is best defined
Syrian national P.C.S prevalence study 2005:
- 47% of participants (20-40 years old) complain of some clinical aspects of PCS -23% of screened women have proven pelvic varicose veins -Higher prevalence of PCS in Syrian female population than in Western countries maybe due to High number of pregnancies, marriages in the same family in Syria and to the style of life.
2006- September 2015 More than 390 case treated by endovascular techniques
mm Pelvic congestion syndrome approach, Tips & tricks
Pelvic congestion syndrome approach Tips & tricks
Indications pelvic varicosities seen in laparoscopy, ultrasounds, MRI, CT
or open surgery with : Otherwise unexplained sever PCS symptoms or Severe labial or perineal varicosities or Related lower extremities varicose veins recurrence
immediately after adequate treatment
Contraindications Iodine allergy , renal failure, asymptomatic patients
preparation Building friendship and confidence with patients Full detailed explanation of the procedure Conscious sedation-analgesic
Endovascular approach the golden standard
Pelvic congestion syndrome approach, Tips & tricks
Pelvic congestion syndrome approach Tips & tricks
Untreated collaterals = recurrence
Pelvic congestion syndrome approach, Tips & tricks
Pelvic congestion syndrome approach Tips & tricks
Guiding and balloon catheter support
Pelvic congestion syndrome approach, Tips & tricks
Pelvic congestion syndrome approach Tips & tricks
Dealing with huge incontinent veins
- transcatheter vein filling with
(Xylocain+contast agent+saline) mixture
- five minutes later lent injection of
some boiled contrast till obtaining
moderate vein spasm.
- Slow injection of foam contrast
mixture ( 2 ml of 3% sclerosing agent
“STS or Polidocanol” + 1 ml of contrast
agent + 2 ml saline + 15 ml air Tssari’s
method agitated) distally then more
and more proximally
Boiled contrast technique
Pelvic congestion syndrome approach, Tips & tricks
Pelvic congestion syndrome approach Tips & tricks
4 axes cartography & treatment
Pelvic congestion syndrome approach, Tips & tricks
Pelvic congestion syndrome approach Tips & tricks
Anomalies = dangerous anatomy
Pelvic congestion syndrome approach, Tips & tricks
Pelvic congestion syndrome approach Tips & tricks
Annular left renal vein
Pelvic congestion syndrome approach, Tips & tricks
Pelvic congestion syndrome approach Tips & tricks
May –Turner syndrome
Pelvic congestion syndrome approach, Tips & tricks
Pelvic congestion syndrome approach Tips & tricks
Related lower limbs varicose veins
Pelvic congestion syndrome approach, Tips & tricks
Pelvic congestion syndrome approach Tips & tricks
Labial, perineal and vulval varicosities
Pelvic congestion syndrome approach, Tips & tricks
Complications :
• variable postembolization syndrome (24-72 h)
(mild pelvic and dorsal pain, fever, nausea)
• rare hematomas, extravasations, DVT, allergy
• chest malaise is frequent but extremely rare gas embolism (pulmonary, neurologic or optical)
General results :
• 95-100% procedure success
• 50-60 % complete pain resolution
• 25-40 % pain amelioration
• More than 85% patients satisfaction
• 10-30% symptoms recurrence in tow years
Pelvic congestion syndrome approach, Tips & tricks
• Overlooked & Underdiagnosed common Gynecologic
pathology
• Major cause of women's invalidism and
both sex postsurgical varicose veins recurrence
• Reflux Endovascular treatment is effective, noninvasive, well tolerated & repetitive
• Foam sclerotherapy is safe & non expensive
• Satisfactory results but experience dependant
Pelvic congestion syndrome approach, Tips & tricks
Conclusion; Pelvic Congestion Syndrome is
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