Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/1677-5449.190061
Jornal Vascular Brasileiro
Review Article

Síndrome da congestão pélvica e embolização de varizes pélvicas

Pelvic congestion syndrome and embolization of pelvic varicose veins

Mateus Picada Corrêa; Larissa Bianchini; Jaber Nashat Saleh; Rafael Stevan Noel; Julio Cesar Bajerski

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Resumo

Resumo: A síndrome da congestão pélvica (SCP) é definida como dor pélvica crônica há mais de 6 meses associada a varizes perineais ou vulvares, resultantes do refluxo ou obstrução das veias gonadais, glúteas ou periuterinas. A SCP é responsável por 16-31% dos casos de dor pélvica crônica, sendo diagnosticada sobretudo na terceira e quarta décadas de vida. Nos últimos anos, houve um interesse maior nessa patologia por parte dos cirurgiões vasculares devido à sua associação com insuficiência venosa de membros inferiores. Apesar de prevalente, a SCP ainda é pouco diagnosticada tanto nos consultórios ginecológicos quanto nos de angiologistas. Portanto, neste artigo revisaremos a etiologia e o diagnóstico desta patologia e os resultados dos diversos tipos de tratamentos disponíveis.

Palavras-chave

varizes, insuficiência venosa, embolização

Abstract

Abstract: Pelvic congestion syndrome (PGS) is defined as chronic pelvic pain for more than 6 months associated with perineal and vulvar varicose veins caused by reflux or obstruction in gonadal, gluteal, or parauterine veins. PGS accounts for 16-31% of cases of chronic pelvic pain, and is usually diagnosed in the third and fourth decades of life. Interest in this condition among vascular surgeons has been increasing over recent years because of its association with venous insufficiency of the lower limbs. Despite its significant prevalence, PGS is still poorly diagnosed in both gynecology and angiology offices. Therefore, in this article we review the etiology and diagnosis of this condition and the outcomes of the different types of treatment available.
 

Keywords

varicose veins, venous insufficiency, embolization

References

Taylor HC Jr. Vascular congestion and hyperemia; their effect on function and structure in the female reproductive organs; the clinical aspects of the congestion-fibrosis syndrome. Am J Obstet Gynecol. 1949;57(4):637-53. http://dx.doi.org/10.1016/0002-9378(49)90704-8. PMid:18113695.

Meissner MH, Gibson K. Clinical outcome after treatment of pelvic congestion syndrome: sense and nonsense. Phlebology. 2015;30(1, Suppl):73-80. http://dx.doi.org/10.1177/0268355514568067. PMid:25729071.

O’Brien MT, Gillespie DL. Diagnosis and treatment of the pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2015;3(1):96-106. http://dx.doi.org/10.1016/j.jvsv.2014.05.007. PMid:26993690.

Asciutto G, Asciutto KC, Mumme A, Geier B. Pelvic venous incompetence: reflux patterns and treatment results. Eur J Vasc Endovasc Surg. 2009;38(3):381-6. http://dx.doi.org/10.1016/j.ejvs.2009.05.023. PMid:19574069.

Lechter A, Lopez G, Martinez C, Camacho J. Anatomy of the gonadal veins: a reappraisal. Surgery. 1991;109(6):735-9. PMid:2042092.

Ahlberg NE, Bartley O, Chidekel N. Right and left gonadal veins. An anatomical and statistical study. Acta Radiol Diagn (Stockh). 1966;4(6):593-601. http://dx.doi.org/10.1177/028418516600400601. PMid:5929114.

Heinz A, Brenner E. Valves of the gonadal veins: an anatomical study. Phlebologie. 2010;39:317-24.

Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc. 2010;85(6):552-9. http://dx.doi.org/10.4065/mcp.2009.0586. PMid:20511485.

Hartung O. Embolization is essential in the treatment of leg varicosities due to pelvic venous insufficiency. Phlebology. 2015;30(1, Suppl):81-5. http://dx.doi.org/10.1177/0268355515569129. PMid:25729072.

Borghi C, Dell’Atti L. Pelvic congestion syndrome: the current state of the literature. Arch Gynecol Obstet. 2016;293(2):291-301. http://dx.doi.org/10.1007/s00404-015-3895-7. PMid:26404449.

Rastogi N, Kabutey NK, Kim D. Incapacitating pelvic congestion syndrome in a patient with a history of May-Thurner syndrome and left ovarian vein embolization. Ann Vasc Surg. 2012;26(5):732.e7-11. http://dx.doi.org/10.1016/j.avsg.2011.08.029. PMid:22664294.

Daugherty SF, Gillespie DL. Venous angioplasty and stenting improve pelvic congestion syndrome caused by venous outflow obstruction. J Vasc Surg Venous Lymphat Disord. 2015;3(3):283-9. http://dx.doi.org/10.1016/j.jvsv.2015.01.003. PMid:26992307.

Santoshi RKN, Lakhanpal S, Satwah V, Lakhanpal G, Malone M, Pappas PJ. Iliac vein stenosis is an underdiagnosed cause of pelvic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2018;6(2):202-11. http://dx.doi.org/10.1016/j.jvsv.2017.09.007. PMid:29292119.

Phillips D, Deipolyi AR, Hesketh RL, Midia M, Oklu R. Pelvic congestion syndrome: etiology of pain, diagnosis, and clinical management. J Vasc Interv Radiol. 2014;25(5):725-33. http://dx.doi.org/10.1016/j.jvir.2014.01.030. PMid:24745902.

Moore CJ. Pelvic Congestion Syndrome Update - Diagnostic and therapeutic options for this often unrecognized condition and one center’s approach to treatment. Endovascular Today. 2011;24-30.

Ignacio EA, Dua IVR 4th, Sarin S, et al. Pelvic congestion syndrome: diagnosis and treatment. Semin Intervent Radiol. 2008;25(4):361-8. http://dx.doi.org/10.1055/s-0028-1102998. PMid:21326577.

Mahmoud O, Vikatmaa P, Aho P, et al. Efficacy of endovascular treatment for pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2016;4(3):355-70. http://dx.doi.org/10.1016/j.jvsv.2016.01.002. PMid:27318059.

Herrera-Betancourt AL, Villegas-Echeverri JD, López-Jaramillo JD, López-Isanoa JD, Estrada-Alvarez JM. Sensitivity and specificity of clinical findings for the diagnosis of pelvic congestion syndrome in women with chronic pelvic pain. Phlebology. 2018;33(5):303-8. http://dx.doi.org/10.1177/0268355517702057. PMid:28379058.

Galego GN, Silveira PG, Bortoluzzi CT, Franklin RN, Ronchi TM. Síndrome da Congestão Venosa Pélvica e resultados do tratamento endovascular: série de casos. J Vasc Bras. 2015;14(3):262-6. http://dx.doi.org/10.1590/1677-5449.0085.

Gültaşli NZ, Kurt A, Ipek A, et al. The relation between pelvic varicose veins, chronic pelvic pain and lower extremity venous insufficiency in women. Diagn Interv Radiol. 2006;12(1):34-8. PMid:16538582.

Labropoulos N, Jasinski PT, Adrahtas D, Gasparis AP, Meissner MH. A standardized ultrasound approach to pelvic congestion syndrome. Phlebology. 2017;32(9):608-19. http://dx.doi.org/10.1177/0268355516677135. PMid:27799418.

Nascimento AB, Mitchell DG, Holland G. Ovarian veins: magnetic resonance imaging findings in an asymptomatic population. J Magn Reson Imaging. 2002;15(5):551-6. http://dx.doi.org/10.1002/jmri.10098. PMid:11997896.

Malgor RD, Spentzouris G, Adrahtas D, Gasparis AP, Tassiopoulos AK, Labropoulos N. The role of duplex ultrasound in the pelvic congestion syndrome workup. J Vasc Surg Venous Lymphat Disord. 2013;1(1):107. http://dx.doi.org/10.1016/j.jvsv.2012.10.027. PMid:26993924.

Malgor RD, Adrahtas D, Spentzouris G, Gasparis AP, Tassiopoulos AK, Labropoulos N. The role of duplex ultrasound in the workup of pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2014;2(1):34-8. http://dx.doi.org/10.1016/j.jvsv.2013.06.004. PMid:26992966.

Yang DM, Kim HC, Nam DH, Jahng GH, Huh CY, Lim JW. Time-resolved MR angiography for detecting and grading ovarian venous reflux: comparison with conventional venography. Br J Radiol. 2012;85(1014):e117-22. http://dx.doi.org/10.1259/bjr/79155839. PMid:21385913.

Arnoldussen CW, de Wolf MA, Wittens CH. Diagnostic imaging of pelvic congestive syndrome. Phlebology. 2015;30(1, Suppl):67-72. http://dx.doi.org/10.1177/0268355514568063. PMid:25729070.

Leiber LM, Thouveny F, Bouvier A, et al. MRI and venographic aspects of pelvic venous insufficiency. Diagn Interv Imaging. 2014;95(11):1091-102. http://dx.doi.org/10.1016/j.diii.2014.01.012. PMid:24630150.

Knuttinen MG, Xie K, Jani A, Palumbo A, Carrillo T, Mar W. Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues. AJR Am J Roentgenol. 2015;204(2):448-58. http://dx.doi.org/10.2214/AJR.14.12709. PMid:25615769.

Gavrilov SG, Karalkin AV, Turischeva OO. Compression treatment of pelvic congestion syndrome. Phlebology. 2018;33(6):418-24. http://dx.doi.org/10.1177/0268355517717424. PMid:28639874.

Edwards RD, Robertson IR, MacLean AB, Hemingway AP. Case report: pelvic pain syndrome--successful treatment of a case by ovarian vein embolization. Clin Radiol. 1993;47(6):429-31. http://dx.doi.org/10.1016/S0009-9260(05)81067-0. PMid:8519153.

Daniels JP, Champaneria R, Shah L, Gupta JK, Birch J, Moss JG. Effectiveness of embolization or sclerotherapy of pelvic veins for reducing chronic pelvic pain: a systematic review. J Vasc Interv Radiol. 2016;27(10):1478-1486.e8. http://dx.doi.org/10.1016/j.jvir.2016.04.016. PMid:27397619.

Hocquelet A, Le Bras Y, Balian E, et al. Evaluation of the efficacy of endovascular treatment of pelvic congestion syndrome. Diagn Interv Imaging. 2014;95(3):301-6. http://dx.doi.org/10.1016/j.diii.2013.09.011. PMid:24183954.

Maleux G, Stockx L, Wilms G, Marchal G. Ovarian vein embolization for the treatment of pelvic congestion syndrome: long-term technical and clinical results. J Vasc Interv Radiol. 2000;11(7):859-64. http://dx.doi.org/10.1016/S1051-0443(07)61801-6. PMid:10928522.

Lopez AJ. Female pelvic vein embolization: indications, techniques, and outcomes. Cardiovasc Intervent Radiol. 2015;38(4):806-20. http://dx.doi.org/10.1007/s00270-015-1074-7. PMid:25804635.

Yamasaki W, Kakizawa H, Ishikawa M, et al. Migration to the pulmonary artery of nine metallic coils placed in the internal iliac vein for treatment of giant rectal varices. Acta Radiol Short Rep. 2012;1(6):1-4. http://dx.doi.org/10.1258/arsr.2012.120024.

Kim HS, Malhotra AD, Rowe PC, Lee JM, Venbrux AC. Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol. 2006;17(2 Pt 1):289-97. http://dx.doi.org/10.1097/01.RVI.0000194870.11980.F8. PMid:16517774.

Bittles MA, Hoffer EK. Gonadal vein embolization: treatment of varicocele and pelvic congestion syndrome. Semin Intervent Radiol. 2008;25(3):261-70. http://dx.doi.org/10.1055/s-0028-1085927. PMid:21326516.

van der Vleuten CJ, van Kempen JA, Schultze-Kool LJ. Embolization to treat pelvic congestion syndrome and vulval varicose veins. Int J Gynaecol Obstet. 2012;118(3):227-30. http://dx.doi.org/10.1016/j.ijgo.2012.04.021. PMid:22727416.

Chung MH, Huh CY. Comparison of treatments for pelvic congestion syndrome. Tohoku J Exp Med. 2003;201(3):131-8. http://dx.doi.org/10.1620/tjem.201.131. PMid:14649734.

Kim KW, Cho JY, Kim SH, et al. Diagnostic value of computed tomographic findings of nutcracker syndrome: correlation with renal venography and renocaval pressure gradients. Eur J Radiol. 2011;80(3):648-54. http://dx.doi.org/10.1016/j.ejrad.2010.08.044. PMid:20869828.

Hartung O, Grisoli D, Boufi M, et al. Endovascular stenting in the treatment of pelvic vein congestion caused by nutcracker syndrome: lessons learned from the first five cases. J Vasc Surg. 2005;42(2):275-80. http://dx.doi.org/10.1016/j.jvs.2005.03.052. PMid:16102626.

Perkov D, Vrkić Kirhmajer M, Novosel L, Popić Ramač J. Transcatheter ovarian vein embolisation without renal vein stenting for pelvic venous congestion and nutcracker anatomy. Vasa. 2016;45(4):337-41. http://dx.doi.org/10.1024/0301-1526/a000547. PMid:27428503.
 

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