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| |  SCVIR MEETING: Minimally-Invasive Therapy Helps Women With Chronic Pelvic Pain SAN FRANCISCO, CA -- March 3, 1998 -- Women with chronic, heavy pain in the pelvic area are finding relief thanks to a non-operative treatment for a problem that frequently goes undiagnosed and untreated, according to research presented today at the 23rd Annual Meeting of the Society of Cardiovascular & Interventional Radiology (SCVIR). "Most of the women I see are at the end of their rope," said Anthony Venbrux, M.D., director of interventional radiology at the Johns Hopkins Medical Institutions, Baltimore, MD., one site of a multicentre study researching the procedure. "They've become dependent on narcotics, they've had multiple surgeries, they've had psychiatric treatment and their sex lives are falling apart." Pelvic congestion syndrome typically strikes women in their 20s through 40s and is caused by varicose veins in the pelvis. Blood travelling through the ovarian veins flows the wrong way and tends to pool in the pelvis, a condition that some women may be predisposed to and that may be aggravated by hormones and childbearing. Interventional radiologists have been able to relieve pain caused by pelvic congestion syndrome in about 80 percent of the women they treat with a procedure called ovarian vein embolization, which non-surgically plugs up the vein. It is estimated up to 15 percent of adult women have varicose veins in the pelvis, which is the female equivalent of testicular varicoceles. Although not all women who have pelvic varicose veins have the pain that characterises pelvic congestion syndrome, those who do describe it as ranging from a mild sensation of heaviness to severe, debilitating pain that can become excruciating during and after sexual intercourse. Often the pain becomes more intense just before or during the menstrual period. In the multicentre study at Johns Hopkins and Tripler Army Medical Center, Hawaii, nine of 11 women who received treatment (82 percent) got total or nearly total relief from their symptoms. One patient reported 60 percent relief of her symptoms after three months. Another patient, who had complicated medical problems, experienced an 80 percent return of her symptoms after one week. The follow-up ranged from one month to 25 months. Also at the SCVIR meeting, a Canadian researcher reported that 18 of 23 women (78 percent) who had undergone ovarian vein embolization at the University of British Columbia Hospital reported significant improvement in their pain. Three (13 percent) reported their symptoms unchanged. The women were followed an average of 15 months. In a separate observation, the researchers noted that of 92 women referred for testing to investigate otherwise unexplained chronic pelvic pain, 47 (51 percent) had pelvic congestion syndrome. The researchers conclude that pelvic congestion syndrome should be considered in women with unexplained pelvic pain. "The treatment is a fairly simple, outpatient procedure that is increasingly being performed by interventional radiologists throughout North America," said Lindsay Machan, M.D., head of angiography and interventional radiology at UBC Hospital. Women who suffer from pelvic congestion syndrome often fail to receive help because many doctors are unfamiliar with it and it is difficult to diagnose, Dr. Machan said. About a quarter of women who have pelvic congestion syndrome resort to hysterectomy, which usually doesn't resolve the problem, he said. "Most doctors aren't aware that a constellation of non-specific symptoms can point to chronic pelvic pain," said Anthony Eclavea, M.D., an interventional radiology resident at Tripler Army Medical Center and the principal investigator for the multicentre study. "They prescribe antibiotics thinking it's a chronic infection, then they try anti-inflammatory medication, but nothing works." Many women seeking treatment have been frustrated because typical diagnostic tests such as ultrasound and surgical laparoscopy do not reveal the problem. An X-ray study of the pelvic veins must be performed while the patient is upright because the veins are decompressed when she is lying down. Interventional radiologists diagnose the problem by inserting a catheter, or small tube, into a vein in the patient's neck, groin or arm and feeding it to the pelvis. A contrast fluid (dye) is injected and an X-ray is performed so the veins are visible. If the imaging reveals a cluster of serpentine veins, the doctor can plug up the ovarian vein that is at the root of the problem by inserting tiny coils or liquids such as glue into it via the catheter. The procedure typically takes less than two hours and requires only light sedation. At times, other abdominal veins such as the iliac are at the root of the problem and are embolized in the same manner. The surgical option is to tie the veins off through laparoscopy or to cut into the pelvis and remove the ovarian veins, both of which require general anesthesia and are intensive procedures with longer recovery periods than embolization. They also don't appear to be as effective, Dr. Machan added.
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