Evaluation of the feasibility, safety, and preliminary effectiveness of coil and foam embolization in patients with venous-origin chronic pelvic pain

TL;DR

This study shows that embolization with polidocanol is a safe and effective treatment for chronic pelvic pain caused by venous issues, with most patients experiencing significant pain relief.

Contribution

The study introduces a combined embolization and sclerotherapy approach for VO-CPP and identifies risk factors for poor outcomes.

Findings

100% technical success rate with significant pain relief by 3 months post-embolization.

83.5% effectiveness at 6 months and 75.9% at final follow-up.

Parity ≥3 and estrogen-dependent disease are independent risk factors for poor prognosis.

Abstract

This study aims to evaluate the safety and efficacy of ovarian vein embolization combined with polidocanol sclerotherapy for Venous-origin chronic pelvic pain (VO-CPP) and to elucidate potential risk factors affecting prognosis.

A total of 158 patients diagnosed with VO-CPP who underwent embolization were enrolled between October 2019 and August 2024. Patients were followed up at 1 month, 3 months, 6 months, and then annually after the embolization through phone calls and outpatient clinic visits. The primary outcome was the proportion of patients achieving an effective response, defined as a decrease in the Visual Analog Scale (VAS) by at least 50% at the final follow-up. Secondary outcomes included technical success, the time to onset of pain relief, complication rates, and risk factors for poor prognosis.

Technical success was achieved in 100% of cases, with most patients experiencing significant pain relief by 3 months post-embolization. The VAS scores at each time point after embolization were significantly lower than those recorded before the procedure, with all differences being statistically significant (p < 0.001). The proportions of clinical effectiveness at 6 months post-embolization and at the final follow-up were 83.5 and 75.9%, respectively. Pain-related symptom recurrence occurred in 9.1% (12/132) of patients within 6 to 15 months. Parity ≥3 (OR, 2.266; 95% CI: 1.034–4.969; p = 0.041) and estrogen-dependent disease (OR, 2.586; 95% CI: 1.177–5.680; p = 0.018) were the independent risk factor for poor prognosis. The complication rate of combined therapy was 7%, with the most common complication being thrombosis of the pelvic veins.

Ovarian vein embolization combined with polidocanol sclerotherapy is a feasible and safe endovascular procedure for the treatment of VO-CPP. Multiparous and comorbidities were the independent risk factor associated with poor prognosis.

Figures