الفهرس 
RELEVANT PELVIC VENOUS ANATOMYOnly 14 pages are availabe for public view
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Abstract
P
elvic congestion syndrome is one of the causes of Chronic Pelvic pain, a poorly understood yet a common condition in women of reproductive age. It accounts for 10-40% of all gynecological referrals to the radiology department. Due to the protean manifestations of chronic pelvic pain it is often overlooked or misdiagnosed specially that most gynecological and laboratory investigations in the affected patients are normal
Pelvic congestion syndrome is a pathology that involves varicosities inside the pelvis. The venous anatomy affected can be generally classified into a visceral network formed of abundant avalvular venous plexuses, which is highly variable in anatomy and a parietal network, which also has many normal variants yet more systematically labeled.
The etiology of pelvic congestion syndrome is multifactorial with both mechanical and hormonal elements being the causative factors. Dilated veins are more frequently present with increased parity and PCS occurs more frequently in multigravid women. The pathophysiology is thought to be related to retrograde flow in incompetent ovarian veins, which is seen in approximately 10% of women, and up to 60% of women with this abnormality can develop PCS.
Diagnosis of P.C.S as a cause of chronic pelvic pain may prove difficult and may require exclusion of other causes of CPP like endometriosis first. Ultrasound and Doppler are considered a 1st line and a useful investigation for PCS. It demonstrates the pelvic varicosities and can reveal retrograde flow in these vessels, further investigations with ct and MRI can add a lot of information on the location and degree of varicosities. MRV has shown great promise and is expected to replace ultrasound as an initial investigation. Phlebography although invasive is the gold standard in diagnosis of PCS. It can demonstrate reflux and also allows detection of anastomosis inside the venous plexus. It also allows treatment by embolization to be commenced at the same session
Many treatment approaches have been used for PCS. from drug therapy with MPA to laparoscopic or surgical ligation of varicosities. Yet they entail either great morbidity or low therapeutic benefit. Percutaneous transcatheter endovenous embolization has been introduced in`1993 by Edwards et al. and has revolutionized the treatment of PCS. Since the introduction of this treatment modality, several modification and variations have emerged. Different percutaneous entry sites have been suggested such as the femoral, transjugular and antecubital veins. Several embolic materials were implemented with coils, foam sclerotherapy or a combination of both, being the most prevalent. Most authors bilateral embolization as a technical success, yet regarded that a left sided approach maybe acceptable in cases where the right ovarian vein could not be accessed.
Despite all the previous variablities in the embolization techniques, all results seemed to be comparable with negligible morbidities and no recorded mortalities. Embolization of pelvic varicosities is considered now as a necessary in treatment of lower limb varicose veins when anastomotic channels are present.