Pelvic congestion syndrome, also known as vulvar varicosities or ovarian reflux, is a common cause of chronic pain in up to 40% of women. PCS is caused by dilation of the ovarian and Pelvic veins in the lower abdomen. The typical age range when a woman develops PCS is from age 20-45 years old.
Pelvic or low back pain that increases after long periods of sitting or standing
Pain after intercourse (dyspareunia)
Pain before the menstrual cycle
Visible varicose veins around the vulva, vagina, inner thigh, and sometimes the buttocks and legs
Painful menstruation (dysmenorrhea)
Abnormal bleeding during menstruation
Swelling of the vagina or vulva
Abnormal tenderness, increased urination, hip pain, and dragging sensation
50% of women with PCS have cystic ovaries
Transvaginal Ultrasounds (the Gold-Standard test)
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT) will provide visualization of incompetent veins and allow for a proper treatment plan
Pelvic Venography is used to provide a definitive diagnosis and provide treatment at the same time
May-Thurner Syndrome ( Compression of the left Iliac vein by the right iliac artery )
Left renal stenosis
Endometriosis, or scarring.
Medications such as NSAIDs or non-steroidal anti-inflammatory drugs, chronic pain medications such as gabapentin and amitriptyline may be used to treat PCS.
Surgical intervention: Ovarian / pelvic vein coil embolization treatment. A catheter is placed into the vein wherein coil emboli (Small medical-grade spheres) are placed into the affected vein blocking the flow of blood in that area, allowing the blood to reroute through healthier veins. This procedure can be done in an outpatient setting and has a 98% success rate and a decrease in pain of 83% of patients in long-term follow-up.
Radiofrequency closure, also known as radiofrequency ablation, addresses the venous reflex disease that often causes varicose veins. It serves as an alternative to traditional vein stripping, which requires invasive surgical removal of the diseased veins. Instead, radiofrequency ablation uses heat energy to prompt the closure of diseased veins.
The surgeon starts by numbing the area with a topical and local anesthetic. Then, by way of a small incision, he or she passes a catheter or similar tool into the affected vein. The catheter serves as a channel through which the surgeon introduces an electrode.
When the surgeon pulls back on the catheter to expose the end of the fiber or electrode, energy passes into the vein as heat. This heat shrinks the collagen in the vein wall, which in turn causes the vein to shrink and close. The surgeon then removes the catheter and the patient’s body proceeds to heal the closure by rerouting blood to healthy veins.
Varicose Veins are veins that have become enlarged and twisted. They can occur anywhere on the body, but most often appear in the arms and legs. Some cases of varicose veins are solely cosmetic, but often they produce pain and discomfort or lead to other circulatory problems. Possible complications include ulcers near the ankles, bleeding, or blood clots.
In healthy leg veins, tiny valves keep blood from pooling in the lower body. When these veins become stretched with age, the valves fail and blood accumulates.
Our Board-certified vascular surgeons have extensive experience treating varicose veins.
Endovenous radiofrequency ablation is a minimally invasive procedure performed by a vascular surgeon that utilizes radiofrequency energy to heat a catheter element which, when inserted into the vein, shrinks the wall of the vessel. This shrinkage or ablation of the vein closes off the blood flow to the incompetent area of the vein allowing the vein to create new healthy pathways where it is needed.
Dr. David Paolini is a Vascular Surgeon with over 15 years of Vascular Surgery experience. Dr. Paolini recently joined Western Vascular Institute as one of our acclaimed vascular surgeons from the Jobst vascular center in Toledo, Ohio. Dr. Paolini has had a passion for medicine and physics from a young age, feeling that Vascular Surgery is the perfect combination of the two scientific areas. Dr. Paolini completed his medical school training from Temple University (One of the best Medical Schools in the united states) in 1999 and after that moved to New Mexico to begin his residency at the University of New Mexico Health Sciences Center Department of Surgery. After completing a 5-year surgical residency Dr. Paolini then moved to Toledo, Ohio to complete a Vascular Surgery specific fellowship at the prestigious Jobst Vascular Center. Dr. Paolini quickly gained accolades as one of the most innovative and competent vascular surgeons in the area as well as being heavily invested in Vascular Surgery research and publications. Dr. Paolini’s care philosophy is “ to take care of patients like you would want your kids’ taken care of ”. As a father of two wonderful children and supported by his beautiful wife Dr. Paolini is poised to join the ranks of the great caring vascular surgeons here at Western Vascular Institute. Dr. Paolini’s previous patients have described dr. Paolini as being kind, compassionate, & honest. We are excited to have Dr. Paolini as part Western Vascular Institute. Dr. Paolini is now accepting new patients in the Mesa and Payson office locations. For an appointment with Dr. Paolini please contact one of our new patient coordinators at (480) 668-5000 ext. 332
Many different doctors treat varicose veins, so why should I see a vascular surgeon specifically?
Many doctors treat varicose veins, but vascular surgeons are specifically trained and board certified to treat such disorders. Vascular surgeons only treat venous and vascular disorders from the time they graduate medical school. These specialists spend their entire career focusing solely on venous and vascular diagnosis, and treatment.
This amount of dedication, and training provides them with a unique, unbiased, expert perspective on causes, treatments and differential diagnosis of these diseases. Differential diagnosis meaning, that even though an individual may have varicose veins, this does not necessarily mean that the varicose veins are the underlying problem. Vascular surgeons are best able to diagnose these underlying problems and are the only physicians that can provide all available treatment options for venous and vascular diseases.
Our doctors have over 65 years of experience and have dedicated their careers to help treat patients with venous and vascular disease. Without a doubt, Western Vascular Institute has the best vascular surgeons in Arizona.
At least 20-25 million Americans suffer from varicose veins which are often inherited and most commonly affect women. This infographic illustrates the signs, symptoms and treatments available at Western Vascular Institute.