Long-term clinical effectiveness of endovenous interventions for pelvic venous disorders

Endovenous therapies are the current standard of care for managing pelvic venous disorders (PeVD) secondary to pelvic venous insufficiency. We previously reported superior short-term results after iliac vein stenting (ST) compared with ovarian vein embolization (OVE). The purpose of this investigation is to determine the long-term durability and clinical effectiveness of endovenous therapies for PeVDs and to identify the time point at which maximal pain reduction is observed.

A retrospective review of prospectively collected data at the Center for Vascular Medicine from October 2016 to October 2022 was performed. Women with a PeVD secondary to an iliac vein stenosis and/or ovarian vein reflux were included. Assessments and interventions consisted of an evaluation for other causes of PeVD by a gynecologist, Clinical-Etiology-Anatomy-Pathophysiology, pre-, 1, 3, 6, 12, 24, and 36 months postoperative visual analog pain scores, transabdominal duplex ultrasound stent surveillance, stent type, diameter, and length. Patients were separated into three treatment groups: pelvic pain alone, leg pain alone or pelvic, and leg pain and analyzed according to treatment type. Patients treated with venoplasty or venoplasty and OVE were excluded. Differences between groups were analyzed using analysis of variance.

A total of 521 women with a PeVD were evaluated and treated with either OVE alone, OVE and ST or ST alone: pelvic pain (n = 33), leg pain (n = 208), and pelvic plus leg (Mixed; n = 280). The average age of the cohort was 52 ± 13.4. Patients with pelvic and mixed pain were younger compared with patients with leg (P ≤ .001). No racial differences by symptom presentation were observed. Patients with pelvic and leg symptoms had a higher prevalence of endometriosis and ovarian cysts (P ≤ .001). The average preintervention ST, OVE and OVE plus ST visual analog scale scores by presentation were the following: pelvic (ST plus OVE, 3.07 ± 3.71; OVE, 5.27 ± 3.2), leg (ST, 6.18 ± 3.07), Mixed (ST, 7.47 ± 2.28; OVE plus ST, 6.67 ± 2.56). Significant improvements in pain scores were observed in all treatment groups. Regardless of the symptom presentation, patients who received OVE plus ST demonstrated significant pain reduction at 1 month with no further decrement in pain that was sustained up to 36 months (P ≤ .001). Patients with ST and OVE alone demonstrated pain reduction up to 3 months with no further pain decrement that was sustained up to 36 months (P ≤ .001).

Women with PeVD often present with concomitant pelvic and lower-extremity venous symptoms. Regardless of the symptomatology or treatment modality, patients report improved and sustained symptom relief up to 36 months. Patients receiving OVE plus ST demonstrated maximal pain reduction at 1 month with sustained relief up to 36 months, whereas patients with OVE or ST alone required 3 months for maximal and sustained pain reduction. These data suggest that combined therapies provide faster pain relief in patients with ovarian vein reflux and iliac vein stenoses. If a staged approach with OVE followed by ST is used, ST should be considered at 3 months as no further improvement at 6 months was observed.