Clinical Connection / February 2019

Video Vignette

Dr. Awais Siddique demonstrates venous ablation in a female patient with a wound history and venous disease. Watch as Dr. Siddique walks viewers through radiofrequency ablation at the AZH Vascular Center in Milwaukee, Wisconsin.


Case of the Month

Pelvic Congestion Syndrome (PCS)

Chronic pelvic pain is a very common problem in the United States. It accounts for 10 to 15 percent of referrals to gynecologists and pain clinics. For some women, the cause of their pelvic pain is a condition known as pelvic congestion syndrome (PCS). It may go undiagnosed simply because physicians are often unfamiliar with it or fail to look for it.

Symptoms of pelvic congestion syndrome (PCS)

Many times, symptoms do not appear until a woman becomes pregnant, and then they continue after the pregnancy. The main symptom of PCS is pelvic pain. The pain typically worsens as the day goes on, especially for women who sit or stand all day, and then goes away after a night of sleep. Learn more about pelvic pain.

The pain can also worsen:

  • During or following intercourse
  • Around menstrual periods
  • After certain physical activities, such as bicycling or horseback riding

Causes of pelvic congestion syndrome (PCS)

Pelvic congestion syndrome occurs when varicose veins develop around the ovaries, similar to varicose veins that occur in the legs. Then:

  1. The valves in the veins no longer function normally.
  2. This causes blood to back up.
  3. The veins become engorged or “congested,” which can be very painful.

Treatment for pelvic congestion syndrome  

After we confirm a diagnosis of PCS, we will discuss treatment options with you. Treatments for PCS include:

  • Hormonal medications
  • Embolization, a minimally invasive catheter procedure to “plug” the varicose vein

Treatment options for pelvic congestion syndrome (PCS)

  • There are several treatment options for pelvic congestion syndrome. Hormonal medications, prescribed by your gynecologist, can reduce blood flow and congestion of the varicose veins. If these are ineffective, then minimally invasive therapies may be considered such as nonsurgical embolization (intentional plugging) of the varicose veins. This is an outpatient procedure, in which an Interventional Radiologist inserts a small catheter (plastic tube) into a central vein in the upper arm, shoulder, or thigh and guides it to the problem area using X-ray guidance. No incisions or stitches are required and there is no sensation inside while this is happening. Intravenous medications are all that is required for comfort and relaxation.
  • The varicose veins are permanently sealed off from the inside. Patients typically return to work and light activities the following day.

This is an example of a 52 year old patient with a history of significant pelvic heaviness, pelvic pressure, frequent urination, dyspareunia and worsening of her symptoms during her menstrual cycle.  

After assessment, the patient clearly met the criteria and had all the defined symptoms of Pelvic Congestion Syndrome.  She agreed to proceed with embolization of her Gonadal vein, as all previous conservative management efforts had failed.  

The patient was placed on the angiographic table using standard techniques and an approach to the lesion was performed using ultrasound guidance.  The left renal venography demonstrated significant reflux into the Left Gonadal vein. Superselective venography of the left gonadal vein was performed.  

Post procedure, the patient was immediately able to sit up, and restored normal activity.  She was monitored for 2 hours and then discharged to home. Follow up at Three weeks demonstrated complete resolution of the patient’s symptoms.  Her quality of life had significantly improved. Gonadal Vein embolization, is an efficacious and minimally invasive procedure, best suited for an Office Based Lab, such as AZH/WAVE centers, when it can be performed under conscious sedation, in a Joint Commissioned Certified Facility, where as in a hospital setting it would be 30-50% more expensive then in our setting.


Services and Technologies


AZH Vascular Center provides comprehensive care for patients with manifestations of peripheral arterial vascular and venous disease. The AZH vascular team will provide care in an environment designed with the experience of patients and families in mind. To facilitate the workup of patients onsite non-invasive vascular diagnostic studies are performed.  AZH Vascular Center will focus on interventions to address manifestations of peripheral vascular disease such as claudication, mesenteric ischemia, renal artery stenosis as a cause of hypertension, and critical limb ischemia. Additionally, there are other interventions such as treatment for venous insufficiency manifesting as venous stasis ulcers, salvage procedures to preserve the function of dialysis access, transcatheter treatment of certain conditions via embolization which can safely be performed in the office-based procedure setting in a timely and convenient manner.  Intervention will be accomplished via imaging-guided interventions utilizing state of the art equipment and technology.


AZH All Star


Dr. Siders accepted the role of Director of Operations in November of 2018. Prior to taking this position, he worked in the Medical Device industry, with focus on Peripheral Arterial Disease and Venous Disease. Dr. Siders gained vast experience in the dynamics associated Office Based Labs in The Mid-Atlantic region. Upon hearing about AZH; an innovative medical center that specializes in Wound Care, Hyperbaric and Vascular medicine, he was excited to join the team and help it grow. Dr. Siders grew up in Dubai, and moved to Michigan after high school. After completing his undergraduate degree, he moved to Cambridge, England for medical school. Dr. Siders is married and has two young children.

IPN Insider

A message from IPN’s Board President and Medical Director – Dr. Hector Lopez

Now that we are more than 6 weeks into 2019, it is time to think beyond sick care and start thinking about managing your population of patients, especially those in value based contracts.  For primary care physicians, this means that it’s time to start contacting your patients to set up preventive exams (annual wellness exams for seniors, healthchecks for children and physicals for younger adults) to close gaps in care and to document each of the various diagnoses that a patient has.  Insuring that each of the preventive services required for your patients and proper documentation of the disease status of the patients is a requirement of any value based agreement.  Getting a jumpstart on the process now will insure that we meet the mandatory base requirements of the various IPN Commercial, Medicaid and Medicare value based agreements.  

While the preventive measures are mostly focused on primary care, the outcome measures cross all specialties within IPN.  The outcome based measures focus on how well we manage our high risk patients.  These measures include our initial hospitalization rates for specific diseases such as diabetes, our hospital readmission rates and specific disease measures such as diabetic management and hypertension management.  It is critical that primary care physicians and specialists communicate regularly and work together to manage these patients in order to improve the overall health status of these patients.  If you haven’t already done so, now is the time to set up the workflow processes needed to insure the communication between different providers of care.  

If you have any questions, need more information regarding IPN’s value based programs or need help with workflows, feel free to contact me at hlopez@ipn-wi.com  , IPN’s CEO, Mike Repka at mrepka@ipn-wi.com or IPN’s Director of Quality and Clinical Services, Christine Thompson at cthompson@ipn-wi.com.

2019-02-14T16:45:53+00:00February 13th, 2019|