Pelvic Congestion Syndrome

Pulmonary Artery Catheterization

What is pulmonary artery catheterization?

Pulmonary artery catheterization is a procedure using a long, thin tube (catheter) inserted into a pulmonary artery. It can help diagnose and manage many health problems.

The pulmonary artery is the main artery coming from the right ventricle of the heart. This lower chamber of the heart contains blood that's low in oxygen. The pulmonary artery carries this blood to the lungs. There, the blood picks up more oxygen and releases carbon dioxide.

Pulmonary artery catheterization uses a catheter that has an inflatable balloon at its tip. The doctor puts this tube through a large vein. The tube is then moved to the right atrium, one of the heart’s upper chambers. It's then moved on through the right ventricle and out through a pulmonary artery. The doctor then inflates the balloon and wedges it into a small branch of the pulmonary artery. With the catheter in place, the doctor can learn more about pressure in the right side of the heart and in the arteries of the lungs. Blood samples can also be taken at various sites in the heart to understand blood oxygen flow. The procedure can also tell other important details, such as heart output. The findings can help in treating many health conditions.

This procedure can be done at the bedside in the intensive care unit (ICU). It can also be done in the operating room during open-heart surgery or in the cardiac cath lab. The measurement catheter may be used to take a quick measurement. Or it may be left in place for longer monitoring.

Why might I need pulmonary artery catheterization?

Some people in the ICU will need this procedure if they are critically ill. Doctors also may do it as part of a cardiac catheterization procedure. They use it to help diagnose many health problems. These include:

  • Shock.

  • Fluid buildup in the lungs (pulmonary edema).

  • Heart failure.

  • Congenital heart disease.

  • High blood pressure in the lungs (pulmonary hypertension).

Pulmonary artery catheterization can help guide treatment. It can also help your doctor know how serious your illness is. For example, it can help with:

  • Complex heart attacks.

  • Being unstable before or after surgery.

  • High blood pressure near the end of pregnancy (severe preeclampsia).

  • Medicine therapy.

  • Fluid levels in the blood vessels.

  • Burns.

  • Kidney failure.

  • Heart failure.

  • Sepsis.

  • Ventilator management.

What are the risks of pulmonary artery catheterization?

Complications are rare with pulmonary artery catheterization. But it does have risks. Risk factors vary based on your overall health and any other health problems you have. Ask your doctor about your specific risks. Possible risks include:

  • Abnormal heart rhythms, some of which can be life-threatening.

  • Right bundle branch block, which is often short-term (temporary).

  • The catheter getting knotted.

  • A small pulmonary artery bursting open (rupturing).

  • Severely reduced blood flow to part of the lung.

  • Blood clots that can damage the lung.

  • A heart valve infection (endocarditis).

  • Catheter infections.

  • Bleeding at the insertion site.

There is also a risk of inaccurate catheter placement. If this happens, the device can give incorrect information. That can affect treatment.

Doctors always weigh the benefits and risks of the procedure for each person. Risks may be higher for some people. These include older adults and people who have higher pressure in the vessels of the lungs.

How do I get ready for pulmonary artery catheterization?

Ask your doctor how to get ready for this procedure. Follow any directions you're given about not eating or drinking before the procedure. You may also need to stop taking certain medicines, as directed by your doctor.

Your doctor may want some other tests before the procedure. These might include:

  • A chest X-ray.

  • An electrocardiogram to look at heart rhythm.

  • Blood tests, to check general health.

  • An echocardiogram to see blood flow through the heart and to view the fluid around the heart.

Talk with your care team about any allergies that you may have to sedatives, numbing medicines, skin glues, or skin preparations before you have this procedure.

What happens during a pulmonary artery catheterization?

Talk with your doctor about exactly what will happen. A doctor and a special team of nurses will do the procedure. It may take place at the bedside in an ICU. Or it may be done in a special catheterization lab. In general:

  • You'll be awake. You may be given medicine to make you sleepy before the procedure starts.

  • Your vital signs will be closely watched. The care team will be prepared to step in if problems happen.

  • Your doctor will select the blood vessel where they'll insert the catheter. That might be in the arm, in the neck, in the groin, or below the collarbone.

  • The doctor injects a numbing medicine under the skin at the site where the catheter will be inserted.

  • The doctor uses a special needle to enter the blood vessel. They'll put a wire into this vessel.

  • The doctor puts a catheter over this wire, and then removes the wire.

  • The doctor moves a smaller catheter with a balloon at its tip through the blood vessel. They'll use the first tube as a guide.

  • The doctor moves the catheter to the right atrium. They then inflate the balloon at the tip. The doctor will move the tube farther through the right ventricle and then out through a pulmonary artery to a smaller vessel.

  • The doctor may use X-ray images to carefully watch the catheter.

  • When the tube is in position, it will be fastened to the skin with tape or stitches (sutures) so it can’t move.

What happens after a pulmonary artery catheterization?

Ask your doctor about what to expect after the procedure. In general:

  • You may be groggy and disoriented.

  • Your vital signs will be closely watched. These include your heart rate, blood pressure, breathing, and oxygen levels.

  • You'll need a chest X-ray to confirm the position of the catheter. You may need daily X-rays as long as you have the tube.

  • Most people who have pulmonary artery catheterization are very ill. These people may need to stay in the hospital for at least several days.

  • If the tube is needed for more than a few days, it will be removed. A new one will be put in a different site to help prevent infection.

  • When the catheter is no longer needed, it will be removed.

After you leave the hospital:

  • Don’t do vigorous exercise until your doctor says you're ready. Much of your recovery will depend on why you had the procedure.

  • Go to all your follow-up visits with your doctor.

  • Call your doctor if you have a fever, increased draining from where the needle was inserted, chest pain, or any severe symptoms.

  • Follow all your doctor’s instructions on medicine, exercise, diet, and wound care.

Next steps

Before you agree to the test or procedure, make sure you know:

  • The name of the test or procedure.

  • The reason you are having the test or procedure.

  • What results to expect and what they mean.

  • The risks and benefits of the test or procedure.

  • What the possible side effects or complications are.

  • When and where you are to have the test or procedure.

  • Who will do the test or procedure and what that person’s qualifications are.

  • What would happen if you didn't have the test or procedure.

  • Any other tests or procedures to think about.

  • When and how you will get the results.

  • Who to call after the test or procedure if you have questions or problems.

  • How much you will have to pay for the test or procedure.

What is pelvic congestion syndrome?

Pelvic congestion syndrome is a condition that causes chronic pelvic pain. It's thought to be caused by problems with the veins in the pelvic area. This is the lower part of your belly (abdomen).

Veins are the blood vessels that carry blood back to the heart. In some people, veins in the lower abdomen may stop working well. Blood may start to build up inside the veins. When this happens, the veins in your pelvis can enlarge and change shape, like varicose veins. This may lead to the pain and other symptoms of pelvic congestion syndrome.

It happens mostly in people of childbearing age. It may be more common in people who have given birth to more than one child.

What causes pelvic congestion syndrome?

Healthcare providers are trying to understand the possible causes of pelvic congestion syndrome. Enlarged veins in the pelvis seem to play a major role. But many people have enlarged veins and no symptoms. Pregnancy may increase the risk for pelvic congestion syndrome. This is because veins enlarge during pregnancy to support the increased blood flow. This can permanently enlarge the veins and lead to symptoms.

Hormones may also play a role in pelvic congestion syndrome. Estrogen makes veins wider (dilates). This may be why the condition is not common after menopause. Estrogen levels are lower after menopause. Other hormones may also cause veins to grow wider and cause symptoms.

Who is at risk for pelvic congestion syndrome?

You may have a higher risk for pelvic congestion syndrome if you have given birth to more than one child. You may also have a higher risk if other members of your family have it.

What are the symptoms of pelvic congestion syndrome?

The main symptom of pelvic congestion syndrome is pelvic pain that lasts at least 6 months. This pain often first starts during or after a pregnancy. It may get worse after a later pregnancy. The pain may be a heavy or aching feeling. Or the pain may be sharp. Usually the pain is only on one side, usually the left side. At times you may feel it on both sides. The pain is often worse at the end of the day.

Certain factors may make the pain worse, such as:

  • Changing your posture
  • Having sex (both during and after)
  • Standing for a long time
  • Walking

Some people also have symptoms, such as:

  • Pain before or during their periods
  • Feeling a sudden need to urinate
  • Enlarged and distorted veins on the buttocks, external genitals (vulva), or thighs

How is pelvic congestion syndrome diagnosed?

Pelvic congestion syndrome is not easy to diagnose. Pelvic pain is common and there are many different causes. Pelvic pain can result from problems with the reproductive system, like your ovaries and uterus. It can be caused by the urinary system, like your bladder. It can be caused by the gastrointestinal system, such as your large intestine. And it can be caused by muscles or bones. Mental health conditions such as depression are also linked to chronic pelvic pain. Your healthcare provider will need to consider many possible causes before diagnosing the condition.

Your healthcare provider or an OB/GYN healthcare provider may diagnose the condition. They will ask about your health history and your symptoms. You will also have a physical exam. This will likely include a pelvic exam.

You may also need some tests, such as:

  • Urine tests to check for problems with your urinary system
  • Blood tests to check for pregnancy, sexually transmitted infections (STIs), anemia, and other conditions
  • Pelvic ultrasound to look for growths in the pelvis
  • Doppler ultrasound to check the blood flow in the pelvic blood vessels
  • CT scan or MRI for more detailed pictures
  • Diagnostic laparoscopy to rule out other causes of pelvic pain
  • A procedure to take X-rays of the pelvic veins (venography)

How is pelvic congestion syndrome treated?

Your healthcare provider can tailor your treatment according to your symptoms. Possible treatment options include:

  • Gonadotropin-releasing hormone drugs, which block ovarian function and may relieve pain
  • Progestin hormone drugs, which may relieve pain
  • Procedures to shut off damaged veins (sclerotherapy, embolization)
  • Surgery to remove damaged veins
  • Surgery to remove your uterus and ovaries

Your healthcare provider may suggest starting medicines. If these don't relieve your symptoms, your healthcare provider may advise a procedure to treat the condition. Your symptoms may ease up as you enter menopause.

When should I call my healthcare provider?

If your symptoms get worse, plan to see your healthcare provider soon. Pelvic congestion syndrome itself doesn't usually lead to a medical emergency. If you have a sharp, sudden pain that doesn’t go away, see your healthcare provider right away.

Key points about pelvic congestion syndrome

  • Pelvic congestion syndrome is a health condition that causes chronic pelvic pain. The condition is thought to be caused by the enlarged veins in your pelvic area.
  • People of childbearing age who have had more than one pregnancy may have the highest risk for pelvic congestion syndrome.
  • Pelvic pain is the main symptom. This may get worse after standing, walking, or having sex. It may start during or after pregnancy.
  • You may need several tests to rule out other causes of pelvic pain.
  • Hormone treatments may help symptoms.
  • Procedures that block the damaged veins (embolization) or surgery to remove the ovary and tube or the uterus may be choices.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends and holidays.