What Are MIIPs? / Pelvic Congestion Syndrome

Why do I have chronic pelvic pain?

Pain in the lower abdomen or pelvis lasting more than 6 months can have several different causes.  In some women, it may be the result of high blood pressure in the veins of pelvis.  This is called pelvic congestion syndrome (PCS).

What are the symptoms of pelvic congestion syndrome?

• Pelvic pain or pressure lasting more than 6 months
  
• Pelvic pain that is worse with standing or sitting for a long time
• Dilated, visible varicose veins in the thighs, buttocks or vaginal area

  

What causes pelvic congestion syndrome?

Veins normally carry blood from the body back to the heart.  Veins normally have valves that help keep the blood flowing in its usual direction back to the heart.  Without working valves, the blood can flow backwards and pool in the veins, causing them to stretch and bulge.  

  

How is pelvic congestion syndrome diagnosed?

Your doctor may examine you, do a Pap smear to rule out cervical cancer, and order routine blood tests.   Your doctor may order an imaging test like an ultrasound, MRI or a CT scan.  Pelvic congestion syndrome can be difficult to diagnosis.

  

How is pelvic congestion syndrome treated?

Pelvic congestion syndrome can be treated with a same-day minimally invasive, image-guided procedure (MIIP) to block the unhealthy veins from the inside and prevent blood from pooling in the veins of the pelvis.  This procedure is performed by an Interventional Radiologist (IR), who specializes in these procedures. 

  

How can I prepare for my MIIP? 

Before your procedure, you may be asked:

• to stop taking medicines that could make you bleed (examples: aspirin, blood thinners, vitamin E, ibuprofen)
• to not eat or drink after midnight the day of your treatment
• to talk with your doctor if you take insulin for diabetes

   

What is the MIIP to treat pelvic congestion syndrome like?

1. A nurse will start an IV in your arm.
   
2. You will change into a gown for the procedure. 
   
3. You will lie on a table in a special procedure room equipped to take live x-ray pictures. 
   
4. You will get medicine in your IV to make you comfortable and drowsy.  You will still be able to speak and breathe on your own. 
   
5. Your skin will be cleaned and prepared.
   
6. After numbing the skin, the IR will put a thin plastic tube the size of spaghetti into the vein of your upper thigh. 
   
7. The IR will guide the plastic tube into the dilated veins inside of your pelvis while watching with x-rays.  
   
8. The IR doctor will take x-ray pictures of the veins after injecting contrast dye into them.
   
9. The IR will use a special material to block the problem veins so they cannot cause pain.
   
10. The IR will remove the tube and put a bandage over the nick.  No stitches are needed. 

The procedure usually takes 30 minutes to 2 hours.

  

What should I expect after my MIIP?

You will stay in the hospital bed for several hours for observation.  Your IV will be removed and you will be allowed to go home at the end of the day.

You may experience pelvic pain the first 3 days after the treatment.  This pain can be treated successfully with just oral pain medicines in up to 85% of patients. 

  

What are the risks?

The MIIP to treat pelvic congestion syndrome is considered to be very safe.  Complications are rare and the risks are the same for any procedure:

• Bleeding
• Infection
• Damage to surrounding tissues 

Your IR will discuss the risks and benefits with you before your MIIP.

  

For more information about treating pelvic congestion syndrome:

• www.radiologyinfo.org/en/info.cfm?pg=ovariveinembol
  
• www.SIRweb.org/patients/chronic-pelvic-pain/
  

  

References:

1. JVIR 2000; 11:859-864
   
2. AJR 2002; 179:625-627
   
3. JVIR 2002; 13: 171-178
   
4. JVIR 2006; 17:289-297
   
5. Cardiovasc Intervent Radiol 2007; 30:655-661