الفهرس 
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Abstract
Pelvic congestion syndrome (PCS) is a condition that results from incompetent pelvic veins, causing chronic pelvic pain (CPP) in women. The indicators of incompetent veins comprise dysfunctional dilatation of ovarian (OV) and para-uterine veins (PV), slow blood flow (congestion), retrograde flow and reflux. According to the literature, women with PCS-derived CPP are mostly multiparous and describe the abdominal pain as dull and achy with sharp exacerbations, getting worse after long periods of standing and walking. CPP accounts for up to 40% of outpatient gynecologic visits and up to 40% of gynecologic laparoscopies. In addition to individual physical, emotional, and quality-of-life implications of CPP, there are profound healthcare and socioeconomic expenses with estimated annual direct and indirect costs in the United States. Studies have shown that dilated pelvic vessels may also be present in asymptomatic women. PCS is most commonly diagnosed in the third and fourth decades of life and is generally associated with multiparty; however, there are small studies that depict PCS in nulliparous women. Slow flow, inflammation, thrombosis, and insufficiency are thought to be responsible for symptom development as pelvic varices can be present in asymptomatic individuals. Both procedures seemed to have promising outcomes in the management of PCS. However, endovascular management was demonstrated to be more efficient in terms of both pain relief as well as reduction of estradiol level. There was significant correlation between Estradiol level before intervention and pain score (post) in open, Endo groups and all pooled patients. (P value ≤0.005). The high preoperative E2 level can be used as a predictor of pain improvement postintervention Although open technique is more cost effective, endovascular intervention is more effective as regard improvement of symptoms and changes of estradiol level post intervention Limitations: • The main drawback of the current study was the relatively small sample size. Although we are considered large number study in comparison to others. Recommendations: • Further studies are needed in the future on large sample size. • Further studies are needed with Longer follow up periods.