Pelvic congestion syndrome and pelvic varicosities

Tech Vasc Interv Radiol. 2014 Jun;17(2):90-5. doi: 10.1053/j.tvir.2014.02.005.


Pelvic venous insufficiency (PVI), defined as retrograde flow in the gonadal and internal iliac veins, is the underlying cause of pelvic congestion syndrome (PCS), a common cause of disabling chronic pelvic pain in women of child-bearing age. PCS is a chronic pain syndrome characterized by positional pelvic pain that is worse in the upright position and is associated with pelvic and vulvar varicosities as well as symptoms of dyspareunia and postcoital pain. Through collaterals to the lower extremity venous system, PVI may also contribute to varicose vein formation and recurrence in the lower extremities. Endovascular embolization of the ovarian and internal iliac veins has become the treatment of choice for PVI and PCS. This article reviews the pelvic retroperitoneal venous anatomy, pathophysiology of PCS, treatment options and techniques, and clinical outcomes of embolotherapy for PCS.

Keywords: Venous insufficiency; embolization; pelvic pain.

Publication types

  • Review

MeSH terms

  • Embolization, Therapeutic / methods*
  • Female
  • Hemostatics / therapeutic use
  • Humans
  • Pelvic Pain / diagnosis
  • Pelvic Pain / etiology
  • Pelvic Pain / prevention & control*
  • Pelvis / blood supply*
  • Pelvis / diagnostic imaging
  • Radiography, Interventional / methods
  • Varicose Veins / complications
  • Varicose Veins / diagnostic imaging*
  • Varicose Veins / therapy*
  • Venous Insufficiency / complications*
  • Venous Insufficiency / diagnostic imaging
  • Venous Insufficiency / therapy*


  • Hemostatics