David Greuner, M.D., FACS, a vascular surgeon at NYC Surgical Associates, talks about a condition that is very uncomfortable for many women.
Interview conducted by Ivanhoe Broadcast News in December 2016.
Pelvic pain, a lot of people don’t really know about this until it affects them, right?
Dr. Greuner: Pelvic pain is pretty much ambiguous amongst the female population. Most females are told that pelvic pain is just a natural part of their existence. It is normal for a woman, the problem is patient tolerance for pelvic pain, as well as the severity of pelvic pain, has a traumatic and dramatic variation. Some women will tolerate pelvic pain to the extreme extent, some of them will not. Some people will have an extreme extent, some of them will not. In general, only people who are really molested by their pelvic pain will actually seek medical help from the female population; that has been my experience. In our situation, because we question people, we have a specific relationship with them over time. I think because we have a higher level of suspicion, as well as a long term relationship with our patients, we are able to diagnose more pelvic congestion.
Is there a particular main cause of this?
Dr. Greuner: Yes, there are three main causes pelvic congestion syndrome; one is called post compressive congestion, which means if you have a narrowing of a blood vessel, which causes obstruction to blood flow, and pooling of blood. It causes blood to forcefully pool in an area. Basically, instead of blood flowing towards the heart like normal, it backs up or bounces against the narrowing and it will back up somewhere else, causing pooling. That’s one cause of congestion. Another cause is having large children or multiple pregnancies when your baby is in that area which is a fairly enclosed area; it pushes your veins against your spine which also kinks them off. As this happens with larger fetuses or more pregnancies, it typically gets worse and worse, with each pregnancy. The third cause is just simply a genetic component to things where you have abnormal connections to other veins or your veins are just fragile more than others. Some people have thicker skin, some people have thinner skin; some have thin, fragile blood vessels and their just genetically much more prone to develop this.
In a nutshell, what is your procedure doing?
Dr. Greuner: We treat several different things. If it is a post compressive pelvic congestion, we have to open up the narrowed vein so that the blood flows better towards the heart and it does not have to back up anymore, not just treat the congestion. If we don’t treat the narrowing, it’s just going to happen again in a year or so. We typically treat both problems, the compression is treated with a stent which is a minimal-invasive procedure done through an IV and the congestion as well. People that have just congestion that is due to multiple pregnancies, we treat with just an embolization, which means we find all the vessels that are diseased and we treated by injecting Sclerotherapy for varicose veins. In the third situation, where they have abnormal connections to other vessels, we also have to close those abnormal connections to prevent recurrence. We use a coil in that situation and a variety of other devices all that are minimal invasive, all though a catheter and we are able to do this procedure in most cases under local anesthesia, without an incision or downtime.
What did Mindy have done?
Dr. Greuner: She had multiple pregnancies as well as a predisposition genetically to this. She had multiple visits; I believe three in total to address all of her concerns. She had several sources of congestion, so she had embolization or plugging of the veins where blood was pooling, as well as sealing of her extra abnormal connections to ensure minimal risk of recurrence. We actually checked her today. I believe she is a year out now and zero reoccurrence.
And what are we seeing actually on the animation?
Dr. Greuner: Animation is a simplified version of the anatomy of the pathology and it basically shows you the most common source of congestion, which is from a branch of the left kidney vein; it doesn’t show you all the other sources it comes from. It would be too complex to describe every factor for the general population and every single patient is different but almost all patients have at least the situation that’s on the animation.
What are we seeing take place there?
Dr. Greuner: On the animation what you see is a catheter being put into the groin through an IV and without an incision it’s passed up through the intra Vena Cava which is the vein going up towards the heart. You put it in the left kidney vein; from the left kidney vein comes the vein called the ovarian vein and we go down to that vein on the animation. Then it shows you the veins that are obstructed and causing blood pooling which causes the pain. It shows us injecting the solution that seals that area and shows the catheter being withdrawn.
How would you kind of sum up how big of a problem this is?
Dr. Greuner: This is a very, very, very common problem. In women over thirty-five you are looking at almost fifteen percent of the population. Women who have multiple pregnancies, you are looking at probably eighty percent of the population. However, most women just deal with this, or they end up getting a hysterectomy, or what happens is they wait till menopause where things kind of simmer down a little bit when you have the less hormonal fluctuations of menopause, which typically leads to less pain. There is also a huge proportion of women who are suffering unbearable pelvic pain that they don’t need to endure. If these women don’t want to have a hysterectomy and they want to prolong their chance to have children but still don’t want the pain, this is an ideal procedure to do and without local anesthesia, excellent results and very, very efficacious.
It is a sensitive scenario right, because a lot of times it affects sex and relationships and so on, right?
Dr. Greuner: Clearly, very, very often was with our last patient Mindy, it was almost impossible for her to have intercourse with her having significant amount of pain. She was extremely happy about a week after the procedure and so was her husband.
END OF INTERVIEW
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