Endovascular management of pelvic congestion syndrome: An expert consensus statement from the French Society of Cardiovascular Imaging (SFICV), Interventional Radiology Federation (FRI), College of French Radiology Teachers (CERF), and French Society of Women's Imaging (SIFEM)

Pelvic congestion syndrome (PCS) is a major cause of chronic pelvic pain in women of reproductive age. It is often associated with pelvic venous insufficiency and venous dilatation of the ovarian and uterine veins, resulting in a variety of symptoms exacerbated by venous hypertension. Despite its prevalence, PCS lacks standardized diagnostic and management protocols, making effective treatment challenging. The purpose of this expert consensus statement was to summarize the opinions of French radiologists and gynecologists regarding the diagnosis, imaging, treatment, and management of PCS. A working group of 14 expert radiologists and gynecologists from various French medical centers used a Delphi panel approach with several rounds of remote and face-to-face meetings to formulate and refine expert opinions based on the current literature and clinical expertise. These opinions were categorized according to diagnostic criteria, imaging techniques, therapeutic options, and follow-up protocols. The group formulated 72 initial opinions, and 65 were retained after rigorous evaluation for consensus. Key diagnostic tools include Doppler ultrasound for detection of venous reflux and magnetic resonance imaging for detailed assessment of venous anatomy. Endovascular embolization was highlighted as the primary treatment approach and recommended after thorough imaging evaluation. Noninvasive treatments and multidisciplinary care were also emphasized for comprehensive management. The expert opinion also included post-treatment follow-up to assess quality of life and symptom resolution. This structured consensus approach helped develop standardized expert opinions on management of, providing clear guidelines for diagnosis, treatment, and follow-up. These guidelines should improve clinical practice and patient care in the management of PCS.