Ovarian and Internal Iliac Vein Embolization as a Treatment of Pelvic Congestion Syndrome
DESCRIPTION
Pelvic congestion syndrome is a condition of chronic pelvic pain of variable location and intensity, which is associated with dyspareunia and postcoital pain and aggravated by standing. The syndrome occurs during the reproductive years, but unlike endometriosis is not related to parity. Diagnostic criteria are not well defined. The underlying etiology is thought to be related to varices of the ovarian veins, leading to pelvic congestion. As there are many etiologies of chronic pelvic pain, the pelvic congestion syndrome is often a diagnosis of exclusion, with the identification of varices using a variety of imaging methods, such as magnetic resonance imaging (MRI), computed tomography (CT) scanning, or contrast venography. For those who fail medical therapy with analgesics, surgical ligation of the ovarian vein has been considered. More recently, embolization therapy of the ovarian and internal iliac veins has been proposed.
POLICY
Ovarian and internal iliac vein embolization for the treatment of pelvic congestion syndrome is considered investigational.
IMPORTANT REMINDER
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ADDITIONAL INFORMATION
Well-designed, long-term studies in peer-reviewed journals that evaluate the utilization of ovarian and internal iliac vein embolization as a treatment of pelvic congestion syndrome are not available. Therefore, it is not known whether this technology results in safe and effective care.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (5:2011). Ovarian and internal iliac vein embolization as a treatment of pelvic congestion syndrome (4.01.18). Retrieved October 19, 2011 from BlueWeb. (11 articles and/or guidelines reviewed)
Kim, H. S., Malhotra, A. D., Rowe, P. C., Lee, J. M., & Venbrux, A. C. (2006). Embolotherapy for pelvic congestion syndrome: Long-term results. Journal of Vascular Interventional Radiology, 17 (2), 289-297.
Tu, F. F., Hahn, D., & Steege, J. F. (2010) Pelvic congestion syndrome-associated pelvic pain: A systematic review of diagnosis and management. Obstetrical and Gynecological Survey, 65 (5), 332-340. Abstract retrieved October 19, 2011 from PubMed database.
MOST RECENT REVIEW DATE: 12/8/2011
ID_BA
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