Hasjim Bima J, Fujitani Roy M, Kuo Isabella J, Donayre Carlos E, Maithel Shelley, Sheehan Brian, Kabutey Nii-Kabu
Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA.
Division of Vascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA.
Ann Vasc Surg. 2020 Oct;68:569.e1-569.e7. doi: 10.1016/j.avsg.2020.04.008. Epub 2020 Apr 10.
Pelvic congestion syndrome (PCS) is defined as noncyclical pelvic pain or discomfort caused by dilated parauterine, paraovarian, and vaginal veins. PCS is typically characterized by ovarian venous incompetence that may be due to pelvic venous valvular insufficiency, hormonal factors, or mechanical venous obstruction.
We describe a case of a 38-year-old multiparous female with a history of pelvic pressure, vulvar varices, and dyspareunia. She underwent left gonadal vein coil embolization in 2014 for PCS that lead to symptomatic relief of her pain. Four years later, the patient returned for recurrent symptoms. Magnetic resonance venogram demonstrated dilated pelvic varices. The previously embolized left gonadal vein remained thrombosed, and there was no evidence of right gonadal vein insufficiency. However, catheter-based venography revealed a large, dilated, and incompetent median sacral vein.
Pelvic venography demonstrated left gonadal vein embolization without any evidence of reflux. The right gonadal vein was also nondilated without reflux. Internal iliac venography showed large cross-pelvic collaterals and retrograde flow via a large, dilated median sacral vein. Coil embolization of the median sacral vein resulted in a dramatic reduction of pelvic venous reflux and resolution of symptoms.
Recurrence of PCS can occur after ovarian vein embolization through other tributaries in the venous network. The median sacral vein is a rare cause of PCS. We present an interesting case of a successfully treated recurrent PCS with coil embolization of an incompetent median sacral vein.
盆腔淤血综合征（PCS）定义为由子宫旁、卵巢旁及阴道静脉扩张引起的非周期性盆腔疼痛或不适。PCS的典型特征是卵巢静脉功能不全，这可能是由于盆腔静脉瓣膜功能不全、激素因素或机械性静脉阻塞所致。
我们描述了一例38岁经产妇，有盆腔压迫感、外阴静脉曲张和性交困难病史。她于2014年因PCS接受了左侧性腺静脉线圈栓塞术，疼痛症状得到缓解。四年后，患者因症状复发前来就诊。磁共振静脉造影显示盆腔静脉曲张。先前栓塞的左侧性腺静脉仍有血栓形成，且无右侧性腺静脉功能不全的证据。然而，基于导管的静脉造影显示骶中静脉粗大、扩张且功能不全。
盆腔静脉造影显示左侧性腺静脉栓塞，无任何反流迹象。右侧性腺静脉也未扩张，无反流。髂内静脉造影显示有大量的盆腔交叉侧支循环，且通过粗大、扩张的骶中静脉有逆流。骶中静脉线圈栓塞术使盆腔静脉反流显著减少，症状得以缓解。
卵巢静脉栓塞术后，PCS可通过静脉网络中的其他分支复发。骶中静脉是PCS的罕见病因。我们报告了一例有趣的复发性PCS病例，通过对功能不全的骶中静脉进行线圈栓塞术成功治愈。
