📖 Pelvic congestion syndrome
Pelvic congestion syndrome (PCS) is a frequently under-diagnosed cause of chronic pelvic pain in women, caused by incompetent ovarian or uterine veins leading to pelvic varicosities — similar to varicose veins, but inside the pelvis. It is estimated to affect up to 30% of women with chronic pelvic pain.
Ovarian vein embolization is the reference treatment for PCS. At Cochin AP-HP, embolization is performed via the right femoral vein (or brachial vein), with selective catheterisation of both ovarian veins, under local anaesthesia. For low pelvic varicosities (vulvar, perineal), a complementary transvaginal ultrasound-guided approach may be added. 80–85% of patients experience significant pain reduction. No patient fees.
🎯 Who should be treated?
- Chronic pelvic pain (>6 months) worsening with prolonged standing or after intercourse
- Pelvic varicosities confirmed on MRI or Doppler ultrasound
- Vulvar or lower-limb varicosities of pelvic origin
- May-Thurner syndrome (left iliac vein compression)
- Failure of medical therapy (progestogens, hormonal contraception)
🔧 Access routes
🩺 Right femoral vein (main approach)
Preferred route at Cochin for ovarian vein embolization. Provides access to both ovarian veins via the IVC and left renal vein. Local anaesthesia at the groin puncture site.
💪 Brachial vein (alternative)
Used when femoral access is not feasible or for anatomical reasons. Puncture of the right brachial vein at the elbow under local anaesthesia.
🔍 Transvaginal approach
For low pelvic varicosities (vulvar, perineal) not adequately reached via the systemic venous route. Sclerosing agent injection under ultrasound guidance.
🩻 Pelvic MRI & Doppler pre-procedure
MRI pelvis with venous sequences to map varicosities and plan embolization. Doppler ultrasound to assess ovarian vein diameter and reflux.