Trans-venous occlusion of incompetent pelvic veins for chronic pelvic pain in women: a systematic review

Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome

“…The overall clinical success rate of 76.9% is consistent with values reported in the literature of 60 to 100% 1,2,7,13-17,21-23, with significant pain reduction indicated by VAPS along with a reduction in the average periuterine vein diameters as determined by MR. In two patients (9%), we identified a concomitant cause of CPP after the performance of PVE.…”

“…The endovascular technique, which involves a shorter procedure time and faster postoperative recovery, is preferable to that of venous ligation 11. Various embolizing materials are used in the endovascular technique, including liquid sclerosing agents and metallic coils, and no significant differences in clinical outcomes were observed among the embolizing materials 1,2,11,13,17. In our study, all embolizations were performed with fibered metallic coils.…”

“…Medical management can be achieved with medroxyprogesterone acetate or analogues of gonadotropin-releasing hormone (goserelin acetate), resulting in improvement of symptoms for up to four months that is not sustained long-term 7. As a surgical alternative, hysterectomy with unilateral or bilateral oophorectomy was reported to improve symptoms in up to two-thirds of patients after one year of clinical follow-up 20, whereas other studies did not show significant pain reduction 17. Failure of symptom improvement after hysterectomy may be due to the rich anastomotic periuterine network, which makes it more difficult to complete resection during surgery.…”

“…After occlusion of the insufficient veins, blood flow is diverted by the pelvic anastomotic network to drain the remaining veins, usually for the internal iliac veins. Endovascular treatment is minimally invasive and is performed under local anesthesia, thus enabling faster recovery for patients and shorter hospital stays 11,13,17. Despite the widespread use of the endovascular technique, published studies have used small samples with extensive technical variability and varying relationships between factors involved in the success or failure of clinical response.…”

Pelvic congestion syndrome: the current state of the literature

“…They include thrombophlebitis, embolization of nontarget vessels (1-2 %), recurrence of varices (up to 10 %), and stroke related to paradoxical emboli because of uncontrolled foam. Complications related to drugs administration, such as sedation or hypersensitivity, those related to venous puncture such as hematoma or pneumothorax and those related to radiation exposure, have to be mentioned [35,59,60]. Postembolization abdominal discomfort is reported in up to 14.8 % of patients, but it is usually self-limited or treated with analgesic and anti-inflammatory medications.…”