Pelvic congestion syndrome can be treated operatively with good long-term results.

Pelvic congestion syndrome (PCS) is frequent and underestimated as both symptoms and signs are not specific. Furthermore, patients consult general practitioners as well as specialist gynaecologists, urologists, vascular surgeons and phlebologists who are frequently unaware of this condition. Investigation protocol must first eliminate other diseases with similar clinical disorders and then identify which veins are responsible for PCS related to compression or reflux. Selective venography is the more informative investigation but transvaginal ultrasound examination is a valuable screening test. Outcome analyses after endovenous treatment have been reported in several articles, but no randomized controlled trial is available for comparing various operative treatments knowing that most of them were undertaken after failure of medical treatment. In our experience, about two-thirds of patients were symptom-free after vein compression, stenting, or embolization at middle-term assessment.