Pelvic Congestion Disease with Amplatzer Vascular Plug Embolization: A Case Report

Andy A. Hamisi, Djony E. Tjandra, Yuansun Khosama

Abstract


Pelvic congestion disease is a prevalent condition causing chronic pelvic pain in women, primarily due to venous insufficiency in the pelvic region. Endovascular embolization, particularly using the Amplatzer Vascular Plug (AVP), has emerged as an effective therapeutic option for treating PCD. This case report presents a 34-year-old female with chronic left lower abdominal pain, diagnosed with PCD and successfully treated with AVP embolization. Preoperative diagnostic imaging, including multislice computed tomography (MSCT) and venography, identified left ovarian vein reflux. Following embolization, the patient showed significant symptom relief, with no recurrence during follow-up. Literature indicates that embolization, particularly with AVP, offers superior occlusion and fewer complications compared to traditional coil embolization. The procedure is minimally invasive, with low complication rates, and offers durable long-term results. Despite the effectiveness, there is a need for improved standardization in treatment protocols and classification systems to optimize PCD management. The SVP classification system provides a useful framework, but a more management-oriented approach is necessary for tailored treatment planning.


Keywords


Pelvic Congestion Disease; Amplatzer Vascular Plug; Embolization; Chronic Pelvic Pain; Venous Insufficiency

Full Text:

PDF

References


Raharjo FC, Danang Himawan Limanto. Amplatzer Vascular Plug for Alternate Treatment in Pelvic Congestive Syndrome in RSUD dr. Soetomo: A Case Report. J Indones Vasc Access [Internet]. 2024 Mar 25;4(1):15–7. Available from: https://indovaccessjournal.org/index.php/JINAVA/article/view/41

De Gregorio MÁ, Yamamoto-Ramos M, Fredes A, Serrano-Casorran C, Sierre S, Ciampi-Dopazo JJ, et al. A Comparative Study of a Small Series of Patients (50 Patients) with Pelvic Varicose Veins Treated with Plugs Alone or Plugs and Polidocanol. J Clin Med [Internet]. 2023 Aug 20;12(16):5408. Available from: https://www.mdpi.com/2077-0383/12/16/5408

Castellano D, Boghi A, Comelli C, Di Maggio L, Savio D. Use of A 4 Mm Amplatzer Vascular Plug II in The Treatment of A Renal Arteriovenous Fistula: A Case Report. CVIR Endovasc [Internet]. 2021 Dec 14;4(1):40. Available from: https://cvirendovasc.springeropen.com/articles/10.1186/s42155-021-00229-3

Hiremath AD, Sahu RK, Bakare VN, Thakur RR. Type II Amplatzer Vascular Plug in Management of Proximal Splenic Artery Pseudoaneurysm causing Haemosuccus Pancreaticus: A Rare case report. J Clin Diagnostic Res [Internet]. 2025 Apr 1;19(4):3–5. Available from: https://www.jcdr.net/article_fulltext.asp?issn=0973-709x&year=2025&month=April&volume=19&issue=4&page=TD03-TD05&id=20849

Nagatomi S, Ichihashi S, Yamamoto H, Bolstad F, Kichikawa K. Coil-in-Plug Technique Using the Amplatzer Vascular Plug II to Occlude a Portosystemic Shunt. Vasc Endovascular Surg [Internet]. 2022 Jan 8;56(1):121–5. Available from: https://journals.sagepub.com/doi/10.1177/15385744211032454

Alrashidi I, Alharbi R, Shin JH. Percutaneous Embolization of Contained Iatrogenic Vesicourethral Fistula Using AVP and NBCA: A Case Report. Polish J Radiol [Internet]. 2021 Aug 24;86:500–3. Available from: https://www.polradiol.com/Percutaneous-embolization-of-contained-iatrogenic-vesicourethral-fistula-using-AVP,124716,0,2.html

Matei SC, Dumitru C ?tefania, Opri?oiu AI, Marian L, Murariu MS, Olariu S. Female Gonadal Venous Insufficiency in a Clinical Presentation Which Suggested an Acute Abdomen—A Case Report and Literature Review. Medicina (B Aires) [Internet]. 2023 May 4;59(5):884. Available from: https://www.mdpi.com/1648-9144/59/5/884

Basile A, Failla G, Gozzo C. Pelvic Congestion Syndrome. Semin Ultrasound, CT MRI [Internet]. 2021 Feb;42(1):3–12. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0887217120300822

Bookwalter CA, VanBuren WM, Neisen MJ, Bjarnason H. Imaging Appearance and Nonsurgical Management of Pelvic Venous Congestion Syndrome. RadioGraphics [Internet]. 2019 Mar;39(2):596–608. Available from: http://pubs.rsna.org/doi/10.1148/rg.2019180159

Kuo CH, Martingano DJ, Singh P. Pelvic Congestion Syndrome [Internet]. StatPearls [Internet]: StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560790/

Ortega MA, Fraile-Martínez O, García-Montero C, Álvarez-Mon MA, Chaowen C, Ruiz-Grande F, et al. Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management. J Clin Med [Internet]. 2021 Jul 22;10(15):3239. Available from: https://www.mdpi.com/2077-0383/10/15/3239

Ba?abuszek K, Toborek M, Pietura R. Comprehensive Overview of The Venous Disorder Known as Pelvic Congestion Syndrome. Ann Med [Internet]. 2022 Dec 31;54(1):22–36. Available from: https://www.tandfonline.com/doi/full/10.1080/07853890.2021.2014556

Gavrilov S, Karalkin A, Mishakina N, Efremova O, Grishenkova A. Relationships of Pelvic Vein Diameter and Reflux with Clinical Manifestations of Pelvic Venous Disorder. Diagnostics [Internet]. 2022 Jan 7;12(1):145. Available from: https://www.mdpi.com/2075-4418/12/1/145

Bartl T, Wolf F, Dadak C. Pelvic Congestion Syndrome (PCS) as A Pathology of Postmenopausal Women: A Case Report With Literature Review. BMC Womens Health [Internet]. 2021 Dec 27;21(1):181. Available from: https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-021-01323-3

Newman L, Chopra J, Dossett C, Shepherd E, Bercusson A, Carroll M, et al. The Impact of Primary Ciliary Dyskinesia on Female and Male Fertility: A Narrative Review. Hum Reprod Update [Internet]. 2023 May 2;29(3):347–67. Available from: https://academic.oup.com/humupd/article/29/3/347/7017573

Potla N, Veluri SC, Stead TS, Dubey J, Ganti L. Pelvic Congestion Syndrome in a Postmenopausal Female. Cureus [Internet]. 2021 Aug 25;13(8):e17444. Available from: https://www.cureus.com/articles/68333-pelvic-congestion-syndrome-in-a-postmenopausal-female

Lamvu G, Carrillo J, Ouyang C, Rapkin A. Chronic Pelvic Pain in Women. JAMA [Internet]. 2021 Jun 15;325(23):2381. Available from: https://jamanetwork.com/journals/jama/fullarticle/2781048

Kashef E, Evans E, Patel N, Agrawal D, Hemingway AP. Pelvic Venous Congestion Syndrome: Female Venous Congestive Syndromes and Endovascular Treatment Options. CVIR Endovasc [Internet]. 2023 Apr 20;6(1):25. Available from: https://cvirendovasc.springeropen.com/articles/10.1186/s42155-023-00365-y

Osman AM, Mordi A, Khattab R. Female Pelvic Congestion Syndrome: How Can CT and MRI Help in The Management Decision? Br J Radiol [Internet]. 2021 Feb 1;94(1118):1–8. Available from: https://academic.oup.com/bjr/article/doi/10.1259/bjr.20200881/7452359

Marcelin C, Le Bras Y, Molina Andreo I, Jambon E, Grenier N. Diagnosis and Management of Pelvic Venous Disorders in Females. Diagnostics [Internet]. 2022 Sep 27;12(10):2337. Available from: https://www.mdpi.com/2075-4418/12/10/2337

Meissner MH, Khilnani NM, Labropoulos N, Gasparis AP, Gibson K, Greiner M, et al. The Symptoms-Varices-Pathophysiology Classification of Pelvic Venous Disorders: A Report of The American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. Phlebol J Venous Dis [Internet]. 2021 Jun 13;36(5):342–60. Available from: https://journals.sagepub.com/doi/10.1177/0268355521999559

Gong JM, Du JS, Han DM, Wang XY, Qi SL. Reasons For Patient Non-Compliance with Compression Stockings as A Treatment For Varicose Veins in The Lower Limbs: A Qualitative Study. Serra R, editor. PLoS One [Internet]. 2020 Apr 28;15(4):e0231218. Available from: https://dx.plos.org/10.1371/journal.pone.0231218

Bendek B, Afuape N, Banks E, Desai NA. Comprehensive Review of Pelvic Congestion Syndrome: Causes, Symptoms, Treatment Options. Curr Opin Obstet Gynecol [Internet]. 2020 Aug;32(4):237–42. Available from: https://journals.lww.com/10.1097/GCO.0000000000000637

Gavrilov SG, Moskalenko YP, Karalkin A V. Effectiveness and Safety of Micronized Purified Flavonoid Fraction For The Treatment of Concomitant Varicose Veins of The Pelvis and Lower Extremities. Curr Med Res Opin [Internet]. 2019 Jun 3;35(6):1019–26. Available from: https://www.tandfonline.com/doi/full/10.1080/03007995.2018.1552043

Rezaei-Kalantari K, Fahrni G, Rotzinger DC, Qanadli SD. Insights Into Pelvic Venous Disorders. Front Cardiovasc Med [Internet]. 2023 Jan 19;10:1–9. Available from: https://www.frontiersin.org/articles/10.3389/fcvm.2023.1102063/full

Katz L, Fransson A, Patterson L. The Development and Efficacy of An Interdisciplinary Chronic Pelvic Pain Program. Can Urol Assoc J [Internet]. 2020 Nov 17;15(6):23–8. Available from: https://cuaj.ca/index.php/journal/article/view/6842

Sutanto SA, Tan M, Onida S, Davies AH. A Systematic Review on Isolated Coil Embolization For Pelvic Venous Reflux. J Vasc Surg Venous Lymphat Disord [Internet]. 2022 Jan;10(1):224-232.e9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213333X21003899

Fukazawa T, Tabei T, Nirei T, Shinoki R, Tsutsumi S, Imano M, et al. A Case of Pelvic Congestion Syndrome Successfully Treated with Endovascular Therapy. Japanese J Urol [Internet]. 2020 Oct 20;111(4):150–3. Available from: https://www.jstage.jst.go.jp/article/jpnjurol/111/4/111_150/_article/-char/ja/

Jambon E, Le Bras Y, Coussy A, Petitpierre F, Hans H, Lasserre A, et al. Embolization in Pelvic Venous Disorders Using Ethylene Vinyl Alcohol Copolymer (Onyx®) and Aetoxysclerol: A Prospective Evaluation of Safety and Long-Term Efficacy. Eur Radiol [Internet]. 2022 Jul 8;32(7):4679–86. Available from: https://link.springer.com/10.1007/s00330-022-08567-z

Corvino F, Giurazza F, Coppola M, Tomasello A, Coletta F, Sala C, et al. Chronic Pelvic Pain in Congestion Pelvic Syndrome: Clinical Impact and Electromyography Pelvic Floor Activity Prior to and after Endovascular Treatment. J Pers Med [Internet]. 2024 Jun 20;14(6):661. Available from: https://www.mdpi.com/2075-4426/14/6/661




DOI: https://doi.org/10.32502/sm.v16i2.10665

Refbacks

  • There are currently no refbacks.


Copyright (c) 2026 Andy A. Hamisi, Djony E. Tjandra, Yuansun Khosama

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Syifa Medika: Jurnal Kedokteran dan Kesehatan Abstracted/Indexed by:

 

Creative Commons Licence
Syifa Medika: Jurnal Kedokteran dan Kesehatan by https://jurnal.um-palembang.ac.id/syifamedika is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.