BlueCross BlueShield of Tennessee Medical Policy Manual

Ovarian and Internal Iliac Vein Embolization as a Treatment of Pelvic Congestion Syndrome


Pelvic congestion syndrome (PCS) is a condition of chronic pelvic pain of variable location and intensity that lasts for six or more months. It can be associated with persistent low-back pain, vaginal discharge, dyspareunia, postcoital pain and is aggravated by standing. PCS occurs when valves in the veins of the pelvic region leak and cause blood to flow backward and pool in the veins. Blood pooling in pelvic or ovarian veins may cause engorgement or thrombosis, leading to pain and discomfort. Risk factors associated with PCS include congestion of veins in the lower extremities, hormonal imbalance, multiple pregnancies, and polycystic ovarian disease.

Initial treatment includes psychotherapy and medical therapy (e.g., nonsteroidal anti-inflammatory drugs) and hormonal therapy.  For individuals who fail initial therapy, surgical ligation of the ovarian vein may be considered. Embolization therapy of the ovarian and internal iliac veins has been proposed as an alternative to surgical ovarian vein ligation.  Vein embolization can be performed using a variety of materials including coils, glue and gel foam. 




It is difficult to draw conclusions from the current data due to a lack of placebo control or comparative data from alternative interventions.  Moreover, definitions of pelvic congestion syndrome vary, making it challenging to clearly define a patient population with symptoms arising from pelvic congestion. Randomized controlled trials using well-defined eligibility criteria are needed.  The evidence is insufficient to determine the effects of the technology on health outcomes.


BlueCross BlueShield Association. Evidence Positioning System. (8:2018). Ovarian and internal iliac vein embolization as a treatment of pelvic congestion syndrome (4.01.18). Retrieved February 15, 2019 from (10 articles and/or guidelines reviewed)

Daniels, J., Champaneria, R., Shah, L., Gupta, J., Birch, J., & Moss, J. (2016). Effectiveness of embolization or sclerotherapy of pelvic veins for reducing chronic pelvic pain: a systematic review. Journal of vascular and interventional radiology, 27 (10), 1478-1486. Abstract retrieved March 30, 2017 from PubMed database.

Hocquelet, A., Le Bras, Y., Balian, E., Bouzgarrou, M., Meyer, M., Rigou, G., & Grenier, N. (2014). Evaluation of the efficacy of endovascular treatment of pelvic congestion syndrome. Diagnostic and Interventional Imaging, 95 (3), 301-306. Abstract retrieved March 30, 2017 from PubMed database.

Laborda, A., Medrano, J., de Blas, I., Urtiaga, I., Carnevale, F., & de Gregoria, M. (2013). Endovascular treatment of pelvic congestion syndrome: visual analog scale (VAS) long-term follow-up clinical evaluation in 202 patients. Cardiovascular and Interventional Radiology, 36 (4), 1006-1014. Abstract retrieved March 30, 2017 from PubMed database.

Mahmoud, O., Vikatmaa, P., Aho, P., Halmesmäki, K., Albäck, A., Rahkola-Soisalo, P., et al. (2016). Efficacy of endovascular treatment for pelvic congestion syndrome. Journal of Vascular Surgery, Venous and Lymphatic Disorders, 4 (3), 355-370. Abstract retrieved March 30, 2017 from PubMed database.

Nasser, F., Cavalcante, R., Affonso, B., Messina, M., Carnevale, F., & de Gregorio, M. (2014). Safety, efficacy, and prognostic factors in endovascular treatment of pelvic congestion syndrome. International Journal of Gynaecology and obstetrics, 125 (1), 65-68. Abstract retrieved March 30, 2017 from PubMed database.

Pyra, K., Woźniak, S., Roman, T., Czuczwar, P., Trojanowska, A., Jargiello, T., & Paszkowski, T. (2015). Ginekologia Polska, 86 (5), 346-351. Abstract retrieved March 30, 2017 from PubMed database.




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