Effectiveness of embolization or sclerotherapy of pelvic veins for reducing chronic pelvic pain: a systematic review

PurposeChronic pelvic pain (CPP) in the presence of dilated and refluxing pelvic veins is often described as pelvic congestion syndrome (PCS), although the causal relationship between pelvic vein incompetence and CPP has not been established. Percutaneous embolization is the principal treatment for PCS, with high success rates cited. Our objective was to systematically and critically review the effectiveness of embolization of incompetent pelvic veins.Materials and MethodsA comprehensive search strategy encompassing various terms for pelvic congestion, pelvic pain and embolization was deployed in 17 bibliographic databases, with no restriction on study design. Methodological quality was assessed. The quality and heterogeneity generally precluded meta-analysis. Results were tabulated and described narratively. Results21 prospective case series and one poor quality randomized trial of embolization (involving 1308 women) were identified. Early substantial relief from pain was observed in approximately 75% of women undergoing embolization, which generally increased over time and was sustained. Where pain was measured on a visual analogue scale, statistically significant reductions following treatment were observed in all studies. Re-intervention rates were generally low. There were few data on the impact on menstruation, ovarian reserve or fertility, but no concerns were noted. Transient pain was common following foam embolization, whilst there was a <2% risk of coil migration.ConclusionsEmbolization appears to provide symptomatic relief of chronic pelvic pain in the majority of women and is safe, although the quality of the evidence is low.