Management of Recurrent Pelvic Congestion Syndrome (Multiple Leaking Points)

Background: Women can experience sensations in their lower extremities and/or persistent pelvic pain due to a group of conditions known as pelvic venous diseases (PeVD). A growing number of women, particularly those who have given birth more than once, are being diagnosed with pelvic congestion syndrome (PCS), also known as pelvic venous incompetence (PeVD). Aim: To evaluate the efficacy of Sclerotherapy agent (polidocanol) injection with coiling compared with histoacryal lipidol injection in the Management of recurrent PeVDs. Subjects and methods: From March 2024 through March 2025, thirty patients were included in this prospective comparison study at Al-Azhar University Hospital in Cairo, Egypt. Two groups of patients were analyzed: The first group received sclerotherapy injections of polidocanol and coils, whereas the second group received injections of histoacryal and lipidol. Results: When comparing the two groups, we found no statistically significant differences in CPP duration or VAS, no difference in the percentage of patients reporting a decrease in VAS after treatment, no difference in the percentage of patients reporting satisfaction, and no difference in the percentage of patients reporting complications. Conclusion: Patients with CPP who do not have abnormal findings on standard gynecologic exams should have PeVD suspected. A diagnosis can be reached with venography of the pelvis and ovaries or by using duplex ultrasonography during the Valsalva maneuver. Both Histoacryal and Lipidol and polidocanol with coils percutaneous transcatheter embolization were effective in managing recurrent PCS, but Histoacryal and Lipidol had the advantage. NSAIDs effectively alleviate post-procedure pain and suffering, much to the delight of the patients.