Embolization and Stenting for Pelvic Congestion Syndrome

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Embolization and Stenting for Pelvic Congestion Syndrome

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What Is Pelvic Congestion Syndrome (now called Pelvic Venous Disorders or PeVD)?

Pelvic Congestion Syndrome (PCS) is a medical condition characterised by chronic pelvic pain, painful intercourse and heavy bleeding during menses arising from the presence of varicose veins in the pelvic region. This condition is most commonly observed in women of reproductive age.

The varicose veins develop due to the malfunctioning of valves and pooling of blood in the veins in the pelvis, leading to improper blood flow and symptoms from the stasis of low oxygen containing venous blood in the pelvis .

Symptoms of PCS often include chronic pelvic pain, heavy painful periods, a sensation of heaviness in the legs or pelvis, worsening pain after standing or during sexual intercourse, and visible varicose veins on the buttocks, thighs, or vulva.

Understanding Embolisation

Embolisation is a minimally invasive medical procedure used to block blood vessels, and it is frequently used to treat PCS by targeting and obstructing the varicose veins responsible for symptoms, and reducing the volume of the venous reservoir of pooled blood in the pelvis.

In the context of PCS, embolisation aims to alleviate chronic pelvic pain and reduce venous congestion by preventing blood flow to the affected veins.

The Procedure

Embolisation involves the insertion of a catheter through a small incision, typically in the groin or neck. The catheter is navigated to the targeted pelvic veins using real-time imaging guidance.

Once in position, embolic agents—materials designed to block blood vessels—are released into the varicose veins, effectively shutting off blood flow to the problematic veins.

Types of Embolic Agents

Coils: Metallic coils that induce clotting and block the vein.
Plugs: Devices that physically obstruct the vein.
Sclerosing Agents: Chemical substances that cause the vein walls to stick together and close.

Safety and Considerations

While embolisation is generally safe, it includes potential risks and complications.

These may include:

Allergic Reactions: Occurring in response to the embolic materials or contrast dye used during the procedure.
Infection: A risk associated with any procedure involving incisions or catheter insertion.
Non-target Embolisation: A rare complication where embolic agents unintentionally block blood vessels other than the targeted veins.

Understanding Iliac Vein Stenting for PCS

Stenting is a procedure sometimes used in conjunction with embolization or as a standalone procedure to treat PCS and other vascular conditions. It involves the placement of a stent, a small mesh tube, into a blood vessel or vein, usually the iliac vein, to keep it open and maintain adequate blood flow back to the heart. In the context of PCS, stenting addresses venous obstructions or narrowings that contribute to the formation of varicose veins and resultant pelvic pain.

The Procedure

Guided by imaging techniques like venography and Intravascular ultrasound (IVUS), the stenting procedure is usually performed under a short general anaesthesia, and it begins with the insertion of a catheter into a vein, typically through a small incision in the groin. Guided by imaging techniques, the catheter is navigated to the identified area of narrowing or obstruction. A stent is then deployed at the site of obstruction, expanding to fit the vein’s width and ensuring it remains open, facilitating proper blood flow and relieving venous pressure.

Types of Stents

Self-expanding dedicated venous Stents: Made of a flexible material (Nitinol- a nickel-titanium alloy) that expands to fit the vein’s size upon deployment, these are the stents of choice now.
Balloon-expandable Stents: Expanded to the desired size using a balloon mechanism during the procedure. These were the stents used historically, but have been largely replaced by self expanding Nitinol stents.

Safety and Considerations

Stenting, like any medical procedure, involves potential risks, which may include:

Stent Migration: The stent may move from its original position.
Vein Perforation: There is a possibility of the vein being perforated during the procedure.
In-stent Restenosis: A condition where the vein narrows again within the stent over time.

The Combined Effects of Embolisation and Stenting

In some PCS cases, both embolisation and stenting may be performed together to maximise therapeutic outcomes:

Synergistic Effect: While embolisation addresses varicose veins by blocking them, stenting ensures that the main pelvic veins remain open and functional, addressing different aspects of PCS.
Procedure Coordination: If both procedures are deemed necessary, they may be performed in a single session or staged depending on the person’s condition and treatment plan.

Benefits of Embolisation and Stenting

The treatment of PCS with embolisation and stenting brings several benefits, such as:

Reduction in Pelvic Pain
Both procedures effectively reduce the chronic pelvic pain associated with PCS by either closing off malfunctioning veins or ensuring proper blood flow.
Low Complication Rates
Both procedures are considered safe, with a low risk of complications when performed by experienced interventional radiologists.
Minimally Invasive Nature
Unlike traditional surgery, embolisation and stenting are minimally invasive, involving small incisions and less physical trauma. Patients also typically experience shorter recovery times, allowing for a faster return to daily activities.
Improved Venous Function
Stenting can help restore normal venous blood flow in cases where venous obstructions contribute to PCS, addressing one of the condition’s root causes.Embolisation helps prevent the backward flow of blood, which is a common issue in varicose veins in the pelvis contributing to PCS.

Frequently Asked Questions (FAQs)

How long does it take to recover from these procedures?

Recovery times can vary, but most patients can resume normal activities within one week. Complete healing and maximum symptom improvement may take several weeks to a few months.

Are embolisation and stenting permanent solutions?

While these treatments can offer long-lasting relief, they are not guaranteed permanent solutions. In some cases, additional treatments may be required, especially if new varicose veins develop or stent adjustments are needed.

Can PCS recur after treatment?

Yes, PCS can recur, especially if underlying causes such as hormonal imbalances or venous insufficiency are not adequately managed. Regular follow-up care is important to monitor for recurrence and manage any emerging symptoms.

What are the lifestyle changes recommended after undergoing these procedures?

Patients are often advised to maintain a healthy weight, engage in regular, moderate exercise, and avoid prolonged periods of standing or sitting to help improve venous circulation and prevent symptom recurrence.

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