In Reply to: Case 1001-02 -- Embolization for Pelvic Congestion Syndrome after Hysterectomy and Bilateral Salpingo-Oophorectomy posted by Editor on October 04, 2001 at 12:05:49:
Dan:
This is a great case. I think that most important in these patients is to have a high clinical suspicion. I do not know how common it is to have reflux into an ovarian vein after ooforectomy, but I can tell you that reflux into the left ovarian vein is not uncommon in the female population. I used to do a lot of angiographic work-ups prior to portal hypertensive surgery (mainly for distal splenorenal shunts) and as part of our work-up we used to inject the left renal vein. I can remember seeing several cases of spontaneous, massive reflux into ovarian veins in our female patients. We never used tilting table to demonstrate this reflux and I do not think that it is crucial for diagnosis. This reflux is caused by insufficiency of a small valve in the ovarian vein which is located aprox 1-2 cm before the ovarian vein meets the left renal vein.
In summary, I think that a high clinical suspicion and a dedicated venographic work-up, like you did, will establish the diagnosis.
My question would be: how many patients in whom we perform uterine fibroid embolization could also have pelvic congestion syndrome as part of their symptomatology?