Female Pelvic Vein Embolization: Indications, Techniques, and Outcomes.

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Gynecology

Background:

• Pelvic vein embolization (PVE) was primarily for pelvic venous congestion syndrome (PVC).
• Increasingly, PVE is used for leg varicosities associated with pelvic vein reflux.
• Pelvic venous malformations are a less common indication for PVE.

Purpose of the Study:

• To review the indications and evidence for pelvic vein embolization (PVE).
• To highlight the emerging role of PVE in treating leg varicosities linked to pelvic vein reflux.
• To discuss the current evidence limitations and future research needs for PVE.

Main Methods:

• Review of published studies on PVE for PVC and leg varicosities.
• Analysis of current evidence levels, noting a lack of randomized controlled trials.
• Discussion of imaging findings revealing pelvic venous reflux in women with leg varicosities.

Main Results:

• PVE is effective for PVC, but evidence for leg varicosities is still developing.
• A significant percentage of women with leg varicosities have a refluxing pelvic venous source.
• High recurrence rates of leg varicosities after surgery suggest alternative treatments like PVE are needed.

Conclusions:

• Minimally invasive PVE for pelvic venous incompetence is likely to become more common.
• Further high-level evidence, including randomized controlled trials, is required to establish PVE efficacy.
• Standardization of PVE techniques is necessary based on future prospective studies.