Pelvic Venous Insufficiency (PVI)

Chronic pelvic pain can be complex, with many different causes. One cause in women may be pelvic venous insufficiency (PVI). This is a condition where the normal valves in pelvic veins do not work properly, leading to enlargement of the pelvic veins and causing pain. This can sometimes be called pelvic congestion syndrome (PCS).

Overview and Symptoms

Presentation of pelvic venous insufficiency can be variable, however, classic symptoms include chronic pelvic pain, occurring for more than six months. It often presents itself during or after pregnancy and can worsen with subsequent pregnancies but sometimes is caused by compression of veins in the abdomen.
Symptoms can include:

  • Dull ache or heaviness in the pelvis, often one-sided
  • Pain that increases with standing or prolonged sitting
  • Pain that increases with exercise or menstrual cycle
  • Pain during or after sexual activity (postcoital ache)

Diagnosis and Treatment

Once common causes of pelvic pain are eliminated through urine and blood testing, pelvic venous insufficiency is usually diagnosed through:

  • History and symptoms
  • Physical examination
  • Ultrasound
  • MRI

Several treatments for pelvic venous insufficiency are available.

  • Prescription medication for hormone therapy
  • Embolization or sclerotherapy of ovarian or pelvic veins
  • Ovarian Vein Ligation
  • Hysterectomy with oophorectomy
About Ovarian and Pelvic Vein Embolization

Embolization of your veins may be offered if you are diagnosed with possible pelvic venous insufficiency. This is a day procedure under moderate sedation and is relatively painless. The procedure involves inserting a catheter into a pinhole in the neck or groin and injecting x-ray contrast to understand which way blood is flowing in the ovarian and pelvic veins. If blood is flowing the wrong way, the veins are then closed by placing coils into the vein. Sometimes other medications, such as sclerosants, are added to the vein to help with closure. Partial or complete relief of chronic pelvic pain has been achieved in up to 80% of patients.

To determine whether you’re a candidate for ovarian or pelvic vein embolization, your doctor will go over your medical records and complete a comprehensive evaluation of your current health. If you’re a candidate, we will contact your insurance company for authorization to move forward with the procedure.

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