Effectiveness of different endovascular treatments in management of chronic pelvic pain in women with pelvic congestion syndrome type I: A 12-month follow-up prospective cohort study

Purpose
The study was designed to evaluate pelvic pain reduction during a 12-month follow-up period after different gonadal vein embolization modalities in women with pelvic congestion syndrome (PCS). We present our first report of prospective data collection for embolization of incompetent refluxing gonadal veins in women experiencing pelvic pain at Ain Shams University Hospitals with standard methods of venous reporting. In addition, we also evaluated the effectiveness of some embolic agents in treating pelvic venous insufficiency through close follow-up (12 months) using the visual analog scale (VAS).
Patients and methods
Data were collected from November 2019 and April 2021 from 24 female patients with (type I PCS) chronic pelvic pain, who were recruited prospectively from Ain Shams University Hospital. These patients were referred to our Department of Vascular Surgery from the Department of Gynecology. Their mean age was 34.25 ± 4.33 years, and they were candidates for gonadal veins embolization. Inclusion criteria were women in childbearing period who had chronic pelvic pain for more than 6 months with more than 6-mm gonadal vein diameter by ultrasound with presence of venous reflux. Exclusion criteria were pregnancy, local gynecological diseases like endometriosis and fibroid, type II PCS (reflux secondary to obstructive pathology or external compression), postphelpitic iliac veins, or acute or chronic iliac veins thrombosis. Both gonadal veins were targeted for embolization, and pain level was assessed by VAS before and after treating these veins over 12 months. Clinical and technical success and complications were observed. New tools for symptoms, varices, and pathophysiology as well as lower limb clinical, etiology, anatomy, and pathophysiology tools were our venous standard reporting system that turned our sample into a homogenous cohort group.
Results
Clinical success was 100%, with significant improvement of symptoms and reduction in VAS (<0.001) over the study period.
Conclusion
Gonadal vein embolization is an effective, feasible, and safe method for treating PCS and improves symptoms with a high clinical success rate and high degree of patient satisfaction.