Innovative Approach to Embolization of Pelvic Varices Using Endovaginal Guidance: Methodology and Early Outcomes

Objective: To retrospectively assess the safety and efficacy of endovaginal guidance for embolizing perivaginal varices associated with persistent localized symptoms, including dyspareunia and postcoital pain. Methods: From February 2024 to January 2025, 10 women (median age: 36 years, range: 23-45) underwent pelvic embolization using endovaginal guidance. Eight patients had already undergone endovascular embolization, with persistent perivaginal varices that were inaccessible by this approach, accompanied by dyspareunia or postcoital pain. Primary efficacy was assessed three months post-embolization, defined as a Visual Analog Scale (VAS) score of <2 and a ≥50% decrease. Outcomes were assessed through clinical and imaging follow-up. Results: Technical efficacy was achieved in all procedures (100%). Embolization was performed using Glubran/Lipiodol in eight cases (80%) and Onyx^® in two cases (20%). The primary efficacy of the procedures was 90.0% (9 out of 10 cases). A reduction in dyspareunia and postcoital pain was observed, with median VAS scores decreasing to one and zero, respectively, compared to initial scores of seven and seven (p = 0.002 and p = 0.016) and to scores after endovascular embolization to five and five (p = 0.004 and p = 0.016). No major complications were recorded. Imaging follow-up showed a significant reduction in perivaginal varicosities in all cases. Conclusions: Endovaginal guidance proves to be a fast and effective technique for the embolization of perivaginal varices, highlighting its integration into the principles of personalized medicine.