Servier – Phlebolymphology

Dear Readers,

It is estimated that one third of all women will experience chronic pelvic pain in their lifetime. Recent advances show the pain may be due to pelvic congestion syndrome, which is caused by hard-to-detect varicose veins in the pelvis. According to the VEIN-TERM Transatlantic Interdisciplinary Consensus Document, pelvic congestion syndrome is defined as: “chronic symptoms which may include pelvic pain, perineal heaviness, urgency of micturition and post-coital pain, caused by ovarian and/or pelvic vein reflux and/or obstruction, and which may be associated with vulvar, perineal, and/or lower extremity varices”.

The aim of the current issue, specially dedicated to the topic of pelvic congestion syndrome, is to collect and review existing data about the prevalence, clinical diagnosis, imaging, and treatment options in pelvic congestion syndrome, with a mind to creating uniform criteria for management of this condition. This issue contains seven articles prepared by seventeen authors from fourteen well-known centers.

The first article describes the prevalence of pelvic congestion syndrome and its main manifestations, such as dyspareunia, chronic pain, atypical varicose veins, and so on. Though epidemiological data don’t allow us to make categorical statements, it is obvious that pelvic congestion syndrome is one of the leading causes of chronic pelvic pain in women. In the article, quality of life data from patients with pelvic congestion syndrome are also considered, which confirm the high toll that this medical condition takes on working and social life.

Next, two in-depth articles consider the diagnosis of pelvic congestion syndrome, one of the most difficult steps in its management. Because pelvic congestion syndrome lacks specific symptoms, correct evaluation of all the possible symptoms or manifestations is challenging and extremely important. The results of invasive and noninvasive imaging diagnostic methods (ultrasound, computed tomography angiography, magnetic resonance phlebography, pelvic selective phlebography, etc) define treatment strategy because, on the basis of findings with these methods, it is possible to evaluate the etiology of pelvic congestion syndrome (reflux and/or compression), grade of hemodynamic changes, and the presence of related pathologies of the pelvic area also. A multidisciplinary team approach might be helpful in making a differential diagnosis of pelvic congestion syndrome, as many other diseases of gynecologic, urologic, or neurologic origin may need to be excluded.

Treatment options for pelvic congestion syndrome are considered in detail in three articles. Of course, it should be noted that, nowadays, less-invasive treatments are the method of choice in the management of pelvic congestion syndrome and surgical methods are used only in cases where endovascular therapy is contraindicated. Authors describe in detail the opportunities for and indications of each endovascular method (embolization and stenting) for different variations of pelvic congestion syndrome. The roles of surgical therapy, sclerotherapy, hormonal and venoactive pharmacotherapy, and psychological approaches in treating pelvic congestion syndrome are also touched on.

Our last article reviews the effectiveness of treatments of pelvic congestion syndrome. On the basis of quite a large body of clinical material, percutaneous endovenous techniques are convincingly shown to be a highly efficient, safe, and cost-effective way of treating pelvic congestion syndrome.

We hope that the current issue gives doctors from different specialties who come across pelvic congestion syndrome in everyday clinical practice the opportunity to better recognize, understand, and treat this debilitating syndrome.

Happy reading.
Pier Luigi ANTIGNANI, Javier LEAL MONEDERO, Santiago ZUBICOA EZPELETA, Zaza LAZARASHVILI