Comparative study between foam sclerotherapy and sandwich technique for management of ovarian vein reflux

Pelvic congestion syndrome is a recognized cause of chronic pelvic pain resulting from ovarian or pelvic venous reflux or obstruction, diagnosed mainly by transvaginal duplex and treated medically, surgically, or with endovascular embolization. We aimed this work to compare and emphasize the outcome of two endovenous techniques, foam sclerotherapy and sandwich, for treatment of ovarian vein reflux.

This prospective randomized controlled study was carried out on 40 female patients with pelvic congestion syndrome that lasted more than 6 months and did not respond to medical therapy, with refluxing ovarian vein and a diameter larger than 6 mm. The primary outcome was symptomatic improvement, defined as ≥50% reduction in Visual Analog Scale score from baseline. Secondary outcomes were complications. Patients were divided into two equal groups. Group A (n = 20) underwent foam sclerotherapy with polidocanol 3%, whereas group B (n = 20) underwent the sandwich technique.

Forty patients were included in our study and were followed-up for 1 year after the procedure. The preprocedural vein diameter was significantly larger in patients with diameters >8 mm compared with those with 6 to 8 mm (P < .001). Following the procedure, a reduction in vein diameter and varicosities was observed in both groups, with greater effectiveness in the sandwich technique (group B) among patients with larger vein diameters (>8 mm) (P < .001). Symptomatic improvement was also significantly greater in group B than group A across both size groups (P = .007). Patients of both groups encountered four complications with no significant difference. It is important to highlight that none of these complications included infection, pulmonary embolism, or mortality.

Both techniques are safe and effective; however, the sandwich technique demonstrates greater effectiveness in larger veins (>8 mm), supporting treatment selection based on ovarian vein diameter.