Treatment of Pelvic Congestion Syndrome – LINC 2016

The treatment of pelvic congestion syndrome was a very well attended session at LINC in Leipzig on Tuesday 26th January 2016.

Professor Mark Whiteley of The Whiteley Clinic was a guest lecturer and invited member of the panel. He presented his talk entitled “Efficacy of endovascular therapy for treating pelvic congestion syndrome”.

Prof Mark Whiteley lecturing about the treatment of Pelvic Congestion Syndrome at LINC in Leipzig 2016

During the talk Mark Whiteley was able to use the research performed at The Whiteley Clinic to show that:

• Pelvic Congestion Syndrome should be diagnosed by Transvaginal Duplex using the Holdstock protocol (developed by Judy Holdstock of The Whiteley Clinic)
• Pelvic Congestion Syndrome should NOT be diagnosed by MRI, MRV, CT scanning or Venograms
• MRI, MRV and CT scanning are usually performed lying flat and pelvic veins do not show reflux when lying flat
• MRI, MRV, CT Scanning and venograms usually use the size of the vein to “diagnose” pelvic congestion … but research from The Whiteley Clinic shows that the size of the ovarian vein is irrelevant and leads to wrong diagnosis and treatment – see link here
• On current evidence, the best treatment for pelvic congestion syndrome is embolisation of the pelvic veins under x-ray control with foam sclerotherapy used as an adjunct to the coils

Prof Mark Whiteley on panel for Pelvic Congestion Syndrome at LINC in Leipzig 2016

Treatment of Pelvic Congestion Syndrome – Results

Mark showed that the results from several reported studies into the treatment of pelvic congestion syndrome were disappointing. However these studies had used MRI, MRV, CT Scanning or venography to diagnose the pelvic congestion syndrome and to direct the treatment.

Using the published research from The Whiteley Clinic, Mark was able to show that the sub-optimal results are more likely to be due to incorrect diagnosis and the wrong veins being treated in some patients due to the imaging used in these hospitals.

Mark ended up by suggesting that clinical studies reporting the outcomes of pelvic congestion syndrome should only be presented and published when:

• patients had been diagnosed using the current Gold Standard (Transvaginal Duplex Ultrasound using the Holdstock protocol for diagnosis)
• treatment had been successful proven on a repeat Transvaginal Duplex scan 6 weeks after the treatment procedure

Only then can the clinical improvement be reported knowing that the diagnosis and treatment are correct. Then the true success or otherwise of the treatment of pelvic congestion syndrome can be found.

Prof Mark Whiteley lecturing about the link between Pelvic Congestion Syndrome and varicose veins of legs vulva and vagina at LINC in Leipzig 2016

The Whiteley Protocol^® for the Treatment of Pelvic Congestion Syndrome

Using this research base, the best practice currently for the investigation and treatment of Pelvic Congestion Syndrome is used in The Whiteley Protocol^®.

Currently this is:

• Patients will have the symptoms of Pelvic Congestion Syndrome or vulvar varicose veins, vaginal varicose veins or varicose veins of the legs coming from the pelvis on scanning
• If any of these are present, the patient will be offered a Transvaginal Duplex Ultrasound scan using the Holdstock protocol
• If any pelvic vein reflux is identified, they will be offered coil embolisation under x-ray control with additional foam sclerotherapy if needed
• Patients will be offered a follow up Transvaginal duplex ultrasound scan 6 weeks after treatment to ensure successful ablation of the refluxing veins
• Any patient found to have a narrowed or blocked vein causing obstruction will be offered other investigations that might be necessary. This is a much less common finding and patients who have this problem are identified and then all options are discussed with them before any treatment is considered.