Pelvic stasis syndrome, also known as ovarian vein syndrome, is one of the most important causes of gynecological pelvic pain. The main manifestations of pelvic stasis syndrome are widespread chronic pain, extreme fatigue and certain symptoms of neurological weakness. Chronic lower abdominal pain, low back pain, unpleasant pleasure, extreme fatigue, excessive leukorrhea and dysmenorrhea are the most common of these. Because of the wide range of symptoms involved and the frequent incompatibility of the patient’s conscious symptoms with the objective examination, it is often confused with chronic pelvic inflammatory disease in terms of physical signs.
The main manifestations of pelvic stasis syndrome are a wide range of chronic pain, extreme fatigue and certain symptoms of neurological weakness. Chronic lower abdominal pain, low back pain, unpleasant pleasure, extreme fatigue, excessive leukorrhea and dysmenorrhea are the most common.
The main manifestations of pelvic stasis syndrome are.
1.Lower abdominal pain
2.Low back pain
3.Dysmenorrhea
4.Unpleasant sensuality
Often complains of different degrees of pain during sexual intercourse, mostly deep intercourse pain, some almost unbearable, the next day lower abdominal pain, lumbago, leucorrhea and other symptoms are significantly aggravated, the patient has become bored with sexual life.
5.Extreme fatigue feeling
A sense of fatigue, the inability to complete the work they are burdened with.
6.Excessive leucorrhea
Half of the patients have the symptoms of excessive leucorrhea. The nature of the leucorrhea is mostly clear mucus, without signs of infection.
7.Menstrual changes
Some patients have excessive menstrual changes and are often misdiagnosed as uterine fibroids or uterine hypertrophy because of their uterine hypertrophy. Some patients also have a decrease in menstrual flow compared to before. However, it is accompanied by obvious premenstrual breast pain.
8. Swelling and pain in the vulva and vagina
9.Bladder and urethra symptoms
About 1/3 or more patients have obvious symptoms of frequent urination and painful urination in PMS, but the urine routine examination is normal. Further cystoscopy in certain patients with severe symptoms may reveal venous filling, congestion and edema in the bladder triangle. Individual patients may have hematuria due to rupture of the small stagnant veins.
10.Rectal cramps
Some patients have varying degrees of rectal cramping, rectal pain or rectal pain during defecation, which is more obvious in premenstrual period, especially in those with Ⅲ degree posterior uterus.
Interventional treatment of pelvic stasis syndrome is effective, less invasive and faster recovery
In 1993, Eward et al. reported the first case of pelvic stasis syndrome treated by transcatheter route embolization and achieved good results. The technique used for interventional treatment is ovarian vein embolization. The literature reports that embolization of only the left ovarian vein is sufficient in 90-95% of patients, but if the preoperative examination confirms bilateral ovarian varices, then bilateral ovarian vein embolization should be performed.
Indications
Women of childbearing age with a history of chronic pelvic pain, repeated pelvic inflammatory disease, endovascular disease without improvement by treatment, and pelvic vein stasis syndrome confirmed by laparoscopy or ovarian venography.
Interventional treatment mechanism
Embolization of the ovarian vein causes obstruction and closure of the ovarian venous plexus and other venous plexuses that coincide with it, resulting in a loss of continuous blood flow support, which can significantly improve the symptoms of pelvic stasis.
Basic steps of interventional operation
(1) The femoral vein is percutaneously punctured and the catheter is inserted into the inferior vena cava, then into the left renal vein to show the contrast reversal into the ovarian vein and the paravalvular varicose vein;
(2) The catheter is then further inserted into the ovarian vein and contrast is injected under pressure to show the extensive collateral venous plexus;
(3) Completely occlude the venous plexus trunk and ovarian vein with embolization material, and embolize the right venous plexus trunk and right ovarian vein in the same way.
Commonly used embolization agents include: medical gums, vascular sclerosing agents, gelatin sponge granules and metal microspring coils.
Evaluation of efficacy
Selective ovarian venography is currently the most reliable, sensitive and least invasive method to diagnose pelvic stasis syndrome, and embolization can be performed once the diagnosis is clear. The technical success rate of ovarian vein embolization is 96%-100%, and the technical failures are mainly related to anatomical variants. The efficiency rate after ovarian vein embolization is 75%-100%, which is related to the different selection criteria of indications.
The efficacy is good for those whose clinical symptoms are mainly abdominal pain and poor for those with painful intercourse; the efficacy is significant for those whose angiography suggests severe stasis.