Treatment Algorithm for Patients with Nonthrombotic Iliac Vein Lesions and Venous-Origin Chronic Pelvic Pain

To develop a treatment algorithm for female patients with nonthrombotic iliac vein lesions (NIVLs) and venous-origin chronic pelvic pain (VO-CPP) with ovarian vein (OV) reflux, depending on the hemodynamic significance of iliac vein stenosis.

A prospective cohort study included 89 patients with NIVL and concomitant VO-CPP with the OV reflux. Patients with hemodynamically significant NIVL underwent primary iliac vein stent placement (IVS) (n = 49) or OV embolization (OVE) (n = 10), whereas patients with nonsignificant NIVL (n = 30) underwent only OVE or OV resection (OVR). Treatment effectiveness was assessed by the reduction in VO-CPP and pelvic venous reflux (PVR).

Primary IVS resulted in the VO-CPP and PVR reduction in 69.4% of cases, with a VO-CPP decrease (scores from 7.7 [SD ± 1.6] to 1.4 [SD ± 0.5], P = .01) and PVR type improvement from II-III to 0-I. The remaining 15 patients without changes in VO-CPP and PVR benefited from the secondary OVE 6 months after IVS. Primary OVE was associated with no changes in VO-CPP and PVR. Secondary IVS resulted in a significant reduction in VO-CPP and PVR. In patients with OVE or isolated OVR, improvements in VO-CPP (from 6.8 [SD ± 0.6] to 1.2 [SD ± 0.6], P = .01) and PVR were observed.

In patients with VO-CPP with hemodynamically significant NIVL and OV reflux, IVS may be considered as a first-line treatment option. Patients with nonsignificant NIVL and OV reflux have indications for the isolated OVE or OVR.