Transvaginal Completion Embolization After Transvenous Treatment of Pelvic Venous Disorders

To evaluate the feasibility, safety, and clinical effectiveness of transvaginal embolization as a completion strategy in women with persistent pelvic pain after technically successful transvenous embolization for pelvic venous disorders (PVD).

This retrospective single-center study included 32 consecutive women with persistent symptoms after prior transvenous embolization for PVD. Transvaginal embolization of residual uterovaginal and/or perineal varices was performed under real-time ultrasound and fluoroscopic guidance using an NBCA-ethiodized oil emulsion. Primary endpoint was VAS pain reduction (at rest, during activity, and dyspareunia). Secondary endpoints included CIVIQ-14 quality-of-life scores, technical success, 1-month transvaginal Doppler imaging, and safety. Follow-up was at 1, 3, 6, and 12 months.

Technical success was achieved in all 32 patients (100%). One-month transvaginal Doppler ultrasound confirmed the absence of residual pelvic varices in all cases. No infectious or access-related adverse events occurred. One asymptomatic proximal pulmonary glue migration into the left pulmonary artery was observed; given its proximal location, catheter-directed thrombaspiration was performed successfully, with no clinical sequelae (SIR grade 3). Median VAS scores decreased significantly across all three pain domains from baseline to 12 months (at rest 4 [3-5]→1 [1-2]; during activity 7 [6-8]→1 [1-2]; dyspareunia 8 [7-8]→2 [1-2]; all p < 0.001). Median CIVIQ-14 improved from 59.5 [54-63] to 19 [16-21] (p < 0.001).

Transvaginal embolization was a feasible completion strategy associated with significant symptom improvement in selected patients after transvenous embolization for PVD, supporting the concept that residual pelvic venous reservoirs may contribute to persistent symptoms.