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Vascular Surgery136 papers

Pulmonary congestion

Last edited: 4/13/2026

Overview

Pelvic congestion syndrome (PCS) is characterized by chronic pelvic pain due to dilated and incompetent pelvic veins, often affecting multiparous women 54.

Diagnosis

  • Clinical Presentation: Chronic non-cyclical pelvic pain lasting more than six months 5.
  • Diagnostic Imaging:
    • - Pelvic Venography: Gold standard but invasive 811. - MRI and MR Venography: Useful for detecting venous reflux and congestion 454243. - Ultrasound: Non-invasive, can identify dilated pelvic veins 811. - CT Venography: Can reveal pelvic varicosities and venous reflux 8.
  • Other Tests:
    • - Doppler Ultrasound: Evaluates blood flow patterns 66. - Endoscopic Ultrasonography: Emerging diagnostic tool 31.

    Management

  • First-Line Treatments:
    • - Endovascular Embolization: Using coils, vascular plugs, or foam sclerotherapy (e.g., Onyx, sodium tetradecyl sulfate foam) 2023273337506163. - Medical Management: Micronized purified flavonoid fraction (Daflon) for symptom relief 949.
  • Adjunctive Treatments:
    • - Laparoscopic Procedures: Transperitoneal ligation of ovarian veins 54. - Foam Sclerotherapy: Effective for pelvic varicose veins 329.

    Special Populations

  • Pregnancy: Ovarian vein embolization may impact fertility; outcomes vary 1457.
  • Elderly: Limited specific data; management similar to general population 5.
  • Comorbidities: Considerations for embolization techniques in patients with prior surgeries or anatomical variations 626.

    • Key Recommendations

  • Primary Treatment with Endovascular Embolization: Preferred for definitive management of pelvic congestion syndrome due to high efficacy and safety profiles (Evidence: Strong 203350).
  • Use of Medical Therapy as Adjunct: Micronized purified flavonoid fraction (Daflon) can be considered for symptom management in patients unsuitable for embolization (Evidence: Moderate 949).
  • Diagnostic Imaging with MRI/MR Venography: Recommended for non-invasive detection of venous congestion and reflux (Evidence: Moderate 454243).
  • Laparoscopic Techniques for Specific Cases: Consider laparoscopic ligation of ovarian veins in cases where embolization is not feasible (Evidence: Expert opinion 54).
  • Monitoring in Pregnant Patients: Careful evaluation and individualized treatment plans for pregnant women considering potential impacts on fertility (Evidence: Moderate 1457).

    • References

    1 Lee IH, Lin TY, Sun S, Sun CJ. Medical treatment for pelvic congestion syndrome with flavonoid: A pilot study. Taiwanese journal of obstetrics & gynecology 2025. link 2 Liang E, Wong WYT, Parvez R, Chan M, Brown B. A keep-it-simple embolisation approach to treat pelvic congestion syndrome without compromising clinical effectiveness. Journal of medical imaging and radiation oncology 2025. link 3 Shahat M, Hussein RS, Ahmed AKS. Foam Sclerotherapy in Pelvic Congestion Syndrome. Vascular and endovascular surgery 2023. link 4 Bałabuszek K, Toborek M, Pietura R. Comprehensive overview of the venous disorder known as pelvic congestion syndrome. Annals of medicine 2022. link 5 Basile A, Failla G, Gozzo C. Pelvic Congestion Syndrome. Seminars in ultrasound, CT, and MR 2021. link 6 Gavrilov S, Moskalenko YP, Mishakina NY, Efremova OI, Kulikov VM, Grishenkova AS. Stratification of pelvic venous reflux in patients with pelvic varicose veins. Journal of vascular surgery. Venous and lymphatic disorders 2021. link 7 Arnaoutoglou C, Variawa RS, Zarogoulidis P, Ioannidis A, Machairiotis N. Advances of Laparoscopy for the Diagnosis of Pelvic Congestion Syndrome. Medicina (Kaunas, Lithuania) 2021. link 8 Osman AM, Mordi A, Khattab R. Female pelvic congestion syndrome: how can CT and MRI help in the management decision?. The British journal of radiology 2021. link 9 Bartl T, Wolf F, Dadak C. Pelvic congestion syndrome (PCS) as a pathology of postmenopausal women: a case report with literature review. BMC women's health 2021. link 10 Bendek B, Afuape N, Banks E, Desai NA. Comprehensive review of pelvic congestion syndrome: causes, symptoms, treatment options. Current opinion in obstetrics & gynecology 2020. link 11 Gavrilov SG, Vasilyev AV, Moskalenko YP, Mishakina NY. Diagnostic value of pelvic venography in female patients with pelvic varicose veins and vulvar varicosities. International angiology : a journal of the International Union of Angiology 2020. link 12 Hasjim BJ, Fujitani RM, Kuo IJ, Donayre CE, Maithel S, Sheehan B et al.. Unique Case of Recurrent Pelvic Congestion Syndrome Treated with Median Sacral Vein Embolization. Annals of vascular surgery 2020. link 13 Gavrilov SG, Efremova OI. Surgical aspects of venous pelvic pain treatment. Current medical research and opinion 2019. link 14 Liu J, Han L, Han X. The Effect of a Subsequent Pregnancy After Ovarian Vein Embolization in Patients with Infertility Caused by Pelvic Congestion Syndrome. Academic radiology 2019. link 15 Jurga-Karwacka A, Karwacki GM, Schoetzau A, Zech CJ, Heinzelmann-Schwarz V, Schwab FD. A forgotten disease: Pelvic congestion syndrome as a cause of chronic lower abdominal pain. PloS one 2019. link 16 Almeida GR, Silvinato A, Simões RS, Buzzini RF, Bernardo WM. Pelvic congestion syndrome - treatment with pelvic varicose veins embolization. Revista da Associacao Medica Brasileira (1992) 2019. link 17 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. link 18 Nanavati R, Jasinski P, Adrahtas D, Gasparis A, Labropoulos N. Correlation between pelvic congestion syndrome and body mass index. Journal of vascular surgery 2018. link 19 Steenbeek MP, van der Vleuten CJM, Schultze Kool LJ, Nieboer TE. Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review. Acta obstetricia et gynecologica Scandinavica 2018. link 20 Guirola JA, Sánchez-Ballestin M, Sierre S, Lahuerta C, Mayoral V, De Gregorio MA. A Randomized Trial of Endovascular Embolization Treatment in Pelvic Congestion Syndrome: Fibered Platinum Coils versus Vascular Plugs with 1-Year Clinical Outcomes. Journal of vascular and interventional radiology : JVIR 2018. link 21 Dorobisz TA, Garcarek JS, Kurcz J, Korta K, Dorobisz AT, Podgórski P et al.. Diagnosis and treatment of pelvic congestion syndrome: Single-centre experiences. Advances in clinical and experimental medicine : official organ Wroclaw Medical University 2017. link 22 Kim AS, Greyling LA, Davis LS. Vulvar Varicosities: A Review. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 2017. link 23 Marcelin C, Izaaryene J, Castelli M, Barral PA, Jacquier A, Vidal V et al.. Embolization of ovarian vein for pelvic congestion syndrome with ethylene vinyl alcohol copolymer (Onyx. Diagnostic and interventional imaging 2017. link 24 Siqueira FM, Monsignore LM, Rosa-E-Silva JC, Poli-Neto OB, Castro-Afonso LH, Nakiri GS et al.. Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome. Clinics (Sao Paulo, Brazil) 2016. link05) 25 Borghi C, Dell'Atti L. Pelvic congestion syndrome: the current state of the literature. Archives of gynecology and obstetrics 2016. link 26 Mahmoud O, Vikatmaa P, Aho P, Halmesmäki K, Albäck A, Rahkola-Soisalo P et al.. Efficacy of endovascular treatment for pelvic congestion syndrome. Journal of vascular surgery. Venous and lymphatic disorders 2016. link 27 Jeanneret C, Beier K, von Weymarn A, Traber J. Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches. VASA. Zeitschrift fur Gefasskrankheiten 2016. link 28 O'Brien MT, Gillespie DL. Diagnosis and treatment of the pelvic congestion syndrome. Journal of vascular surgery. Venous and lymphatic disorders 2015. link 29 Gandini R, Konda D, Abrignani S, Chiocchi M, Da Ros V, Morosetti D et al.. Treatment of symptomatic high-flow female varicoceles with stop-flow foam sclerotherapy. Cardiovascular and interventional radiology 2014. link 30 Hocquelet A, Le Bras Y, Balian E, Bouzgarrou M, Meyer M, Rigou G et al.. Evaluation of the efficacy of endovascular treatment of pelvic congestion syndrome. Diagnostic and interventional imaging 2014. link 31 Cho SJ, Lee TH, Shim KY, Hong SS, Goo DE. Pelvic congestion syndrome diagnosed using endoscopic ultrasonography. Phlebology 2014. link 32 Koo S, Fan CM. Pelvic congestion syndrome and pelvic varicosities. Techniques in vascular and interventional radiology 2014. link 33 Nasser F, Cavalcante RN, Affonso BB, Messina ML, Carnevale FC, de Gregorio MA. Safety, efficacy, and prognostic factors in endovascular treatment of pelvic congestion syndrome. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2014. link 34 Tataru G, Popa M, Costin D, Desbrieres J. Microparticles based on natural and synthetic polymers for ophthalmic applications. Journal of biomedical materials research. Part A 2012. link 35 Smith PC. The outcome of treatment for pelvic congestion syndrome. Phlebology 2012. link 36 Viriyaroj V, Akranurakkul P, Muyphuag B, Kitporntheranunt M. Laparoscopic transperitoneal gonadal vein ligation for treatment of pelvic congestion secondary to Nutcracker syndrome: a case report. Journal of the Medical Association of Thailand = Chotmaihet thangphaet 2012. link 37 van der Vleuten CJ, van Kempen JA, Schultze-Kool LJ. Embolization to treat pelvic congestion syndrome and vulval varicose veins. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2012. link 38 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. Annals of vascular surgery 2012. link 39 Meneses LQ, Uribe S, Tejos C, Andía ME, Fava M, Irarrazaval P. Using magnetic resonance phase-contrast velocity mapping for diagnosing pelvic congestion syndrome. Phlebology 2011. link 40 Paraskevas P. Successful ultrasound-guided foam sclerotherapy for vulval and leg varicosities secondary to ovarian vein reflux: a case study. Phlebology 2011. link 41 Freedman J, Ganeshan A, Crowe PM. Pelvic congestion syndrome: the role of interventional radiology in the treatment of chronic pelvic pain. Postgraduate medical journal 2010. link 42 Pandey T, Shaikh R, Viswamitra S, Jambhekar K. Use of time resolved magnetic resonance imaging in the diagnosis of pelvic congestion syndrome. Journal of magnetic resonance imaging : JMRI 2010. link 43 Kim CY, Miller MJ, Merkle EM. Time-resolved MR angiography as a useful sequence for assessment of ovarian vein reflux. AJR. American journal of roentgenology 2009. link 44 Amemiya S, Aoki S, Takao H. Venous congestion associated with developmental venous anomaly: findings on susceptibility weighted imaging. Journal of magnetic resonance imaging : JMRI 2008. link 45 Asciutto G, Mumme A, Marpe B, Köster O, Asciutto KC, Geier B. MR venography in the detection of pelvic venous congestion. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 2008. link 46 Marsh P, Holdstock JM, Bacon JL, Lopez AJ, Whiteley MS, Price BA. Coil protruding into the common femoral vein following pelvic venous embolization. Cardiovascular and interventional radiology 2008. link 47 Thorne C, Stuckey B. Pelvic congestion syndrome presenting as persistent genital arousal: a case report. The journal of sexual medicine 2008. link 48 Gandini R, Chiocchi M, Konda D, Pampana E, Fabiano S, Simonetti G. Transcatheter foam sclerotherapy of symptomatic female varicocele with sodium-tetradecyl-sulfate foam. Cardiovascular and interventional radiology 2008. link 49 Simsek M, Burak F, Taskin O. Effects of micronized purified flavonoid fraction (Daflon) on pelvic pain in women with laparoscopically diagnosed pelvic congestion syndrome: a randomized crossover trial. Clinical and experimental obstetrics & gynecology 2007. link 50 Kim HS, Malhotra AD, Rowe PC, Lee JM, Venbrux AC. Embolotherapy for pelvic congestion syndrome: long-term results. Journal of vascular and interventional radiology : JVIR 2006. link 51 Nicholson T, Basile A. Pelvic congestion syndrome, who should we treat and how?. Techniques in vascular and interventional radiology 2006. link 52 d'Archambeau O, Maes M, De Schepper AM. The pelvic congestion syndrome: role of the "nutcracker phenomenon" and results of endovascular treatment. JBR-BTR : organe de la Societe royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR) 2004. link 53 Pieri S, Agresti P, Morucci M, de' Medici L. Percutaneous treatment of pelvic congestion syndrome. La Radiologia medica 2003. link 54 Gargiulo T, Mais V, Brokaj L, Cossu E, Melis GB. Bilateral laparoscopic transperitoneal ligation of ovarian veins for treatment of pelvic congestion syndrome. The Journal of the American Association of Gynecologic Laparoscopists 2003. link60156-9) 55 Kowalczyk T. A low-tech approach to venous congestion. RN 2002. link 56 Belenky A, Bartal G, Atar E, Cohen M, Bachar GN. Ovarian varices in healthy female kidney donors: incidence, morbidity, and clinical outcome. AJR. American journal of roentgenology 2002. link 57 Venbrux AC, Chang AH, Kim HS, Montague BJ, Hebert JB, Arepally A et al.. Pelvic congestion syndrome (pelvic venous incompetence): impact of ovarian and internal iliac vein embolotherapy on menstrual cycle and chronic pelvic pain. Journal of vascular and interventional radiology : JVIR 2002. link61935-6) 58 Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES. Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. AJR. American journal of roentgenology 2001. link 59 Sugaya K, Miyazato T, Koyama Y, Hatano T, Ogawa Y. Pelvic congestion syndrome caused by inferior vena cava reflux. International journal of urology : official journal of the Japanese Urological Association 2000. link 60 Maleux G, Stockx L, Wilms G, Marchal G. Ovarian vein embolization for the treatment of pelvic congestion syndrome: long-term technical and clinical results. Journal of vascular and interventional radiology : JVIR 2000. link61801-6) 61 Venbrux AC, Lambert DL. Embolization of the ovarian veins as a treatment for patients with chronic pelvic pain caused by pelvic venous incompetence (pelvic congestion syndrome). Current opinion in obstetrics & gynecology 1999. link 62 Cordts PR, Eclavea A, Buckley PJ, DeMaioribus CA, Cockerill ML, Yeager TD. Pelvic congestion syndrome: early clinical results after transcatheter ovarian vein embolization. Journal of vascular surgery 1998. link70062-x) 63 Capasso P, Simons C, Trotteur G, Dondelinger RF, Henroteaux D, Gaspard U. Treatment of symptomatic pelvic varices by ovarian vein embolization. Cardiovascular and interventional radiology 1997. link 64 Mathis BV, Miller JS, Lukens ML, Paluzzi MW. Pelvic congestion syndrome: a new approach to an unusual problem. The American surgeon 1995. link 65 Sichlau MJ, Yao JS, Vogelzang RL. Transcatheter embolotherapy for the treatment of pelvic congestion syndrome. Obstetrics and gynecology 1994. link 66 Hodgson TJ, Reed MW, Peck RJ, Hemingway AP. Case report: the ultrasound and Doppler appearances of pelvic varices. Clinical radiology 1991. link80877-3) 67 Arai K, Takashima T, Matsui O, Kadoya M, Kamimura R. Transient subpleural curvilinear shadow caused by pulmonary congestion. Journal of computer assisted tomography 1990. link 68 Hobbs JT. The pelvic congestion syndrome. British journal of hospital medicine 1990. link 69 Kennedy A, Hemingway A. Radiology of ovarian varices. British journal of hospital medicine 1990. link 70 Craig O, Hobbs JT. Vulval phlebography in the pelvic congestion syndrome. Clinical radiology 1975. link80112-7) 71 Clavero Núñez JA, Ortiz Quintana L, Becerro de Bengoa Callau C. A new method for the diagnosis of pelvic pathologies Part II - interpretation of abnormal images. Acta Europaea fertilitatis 1975. link

    Original source

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      Medical treatment for pelvic congestion syndrome with flavonoid: A pilot study. — Lee IH, Lin TY, Sun S, Sun CJ Taiwanese journal of obstetrics & gynecology (2025)
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      A keep-it-simple embolisation approach to treat pelvic congestion syndrome without compromising clinical effectiveness. — Liang E, Wong WYT, Parvez R, Chan M, Brown B Journal of medical imaging and radiation oncology (2025)
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      Foam Sclerotherapy in Pelvic Congestion Syndrome. — Shahat M, Hussein RS, Ahmed AKS Vascular and endovascular surgery (2023)
    4. [4]
      Comprehensive overview of the venous disorder known as pelvic congestion syndrome. — Bałabuszek K, Toborek M, Pietura R Annals of medicine (2022)
    5. [5]
      Pelvic Congestion Syndrome. — Basile A, Failla G, Gozzo C Seminars in ultrasound, CT, and MR (2021)
    6. [6]
      Stratification of pelvic venous reflux in patients with pelvic varicose veins. — Gavrilov S, Moskalenko YP, Mishakina NY, Efremova OI, Kulikov VM, Grishenkova AS Journal of vascular surgery. Venous and lymphatic disorders (2021)
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      Advances of Laparoscopy for the Diagnosis of Pelvic Congestion Syndrome. — Arnaoutoglou C, Variawa RS, Zarogoulidis P, Ioannidis A, Machairiotis N Medicina (Kaunas, Lithuania) (2021)
    8. [8]
      Female pelvic congestion syndrome: how can CT and MRI help in the management decision? — Osman AM, Mordi A, Khattab R The British journal of radiology (2021)
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      Pelvic congestion syndrome (PCS) as a pathology of postmenopausal women: a case report with literature review. — Bartl T, Wolf F, Dadak C BMC women's health (2021)
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      Comprehensive review of pelvic congestion syndrome: causes, symptoms, treatment options. — Bendek B, Afuape N, Banks E, Desai NA Current opinion in obstetrics & gynecology (2020)
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      Diagnostic value of pelvic venography in female patients with pelvic varicose veins and vulvar varicosities. — Gavrilov SG, Vasilyev AV, Moskalenko YP, Mishakina NY International angiology : a journal of the International Union of Angiology (2020)
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      Unique Case of Recurrent Pelvic Congestion Syndrome Treated with Median Sacral Vein Embolization. — Hasjim BJ, Fujitani RM, Kuo IJ, Donayre CE, Maithel S, Sheehan B et al. Annals of vascular surgery (2020)
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      Sensitivity and specificity of clinical findings for the diagnosis of pelvic congestion syndrome in women with chronic pelvic pain. — Herrera-Betancourt AL, Villegas-Echeverri JD, López-Jaramillo JD, López-Isanoa JD, Estrada-Alvarez JM Phlebology (2018)
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      Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review. — Steenbeek MP, van der Vleuten CJM, Schultze Kool LJ, Nieboer TE Acta obstetricia et gynecologica Scandinavica (2018)
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      A Randomized Trial of Endovascular Embolization Treatment in Pelvic Congestion Syndrome: Fibered Platinum Coils versus Vascular Plugs with 1-Year Clinical Outcomes. — Guirola JA, Sánchez-Ballestin M, Sierre S, Lahuerta C, Mayoral V, De Gregorio MA Journal of vascular and interventional radiology : JVIR (2018)
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      Diagnosis and treatment of pelvic congestion syndrome: Single-centre experiences. — Dorobisz TA, Garcarek JS, Kurcz J, Korta K, Dorobisz AT, Podgórski P et al. Advances in clinical and experimental medicine : official organ Wroclaw Medical University (2017)
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      Vulvar Varicosities: A Review. — Kim AS, Greyling LA, Davis LS Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] (2017)
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      Embolization of ovarian vein for pelvic congestion syndrome with ethylene vinyl alcohol copolymer (Onyx — Marcelin C, Izaaryene J, Castelli M, Barral PA, Jacquier A, Vidal V et al. Diagnostic and interventional imaging (2017)
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      Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome. — Siqueira FM, Monsignore LM, Rosa-E-Silva JC, Poli-Neto OB, Castro-Afonso LH, Nakiri GS et al. Clinics (Sao Paulo, Brazil) (2016)
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      Efficacy of endovascular treatment for pelvic congestion syndrome. — Mahmoud O, Vikatmaa P, Aho P, Halmesmäki K, Albäck A, Rahkola-Soisalo P et al. Journal of vascular surgery. Venous and lymphatic disorders (2016)
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      Treatment of symptomatic high-flow female varicoceles with stop-flow foam sclerotherapy. — Gandini R, Konda D, Abrignani S, Chiocchi M, Da Ros V, Morosetti D et al. Cardiovascular and interventional radiology (2014)
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      Use of time resolved magnetic resonance imaging in the diagnosis of pelvic congestion syndrome. — Pandey T, Shaikh R, Viswamitra S, Jambhekar K Journal of magnetic resonance imaging : JMRI (2010)
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