骨盤静脈疾患に対するバシリック静脈アクセスを用いた新規血管内熱焼灼術：前向き記述的研究

Pelvic venous disorders (PVD) causing pelvic congestion syndrome are a frequent, underdiagnosed source of chronic pelvic pain. Standard coil/sclerosant embolization may be limited by migration, incomplete occlusion, post-embolization syndrome, symptom recurrence, and cost. Endovenous thermal ablation (EVLA) could provide precise, device-free closure with faster recovery and lower cost.

Evaluate the feasibility, safety, and early efficacy of basilic-access 1470-nm EVLA for refluxing gonadal veins in women with PVD.

Prospective, single-center descriptive cohort study (January-June 2025). Ten women (18-50 years) with chronic pelvic pain refractory to conservative therapy and Doppler-confirmed pelvic varices (venous diameter >6 mm, low-flow waveforms, or Valsalva-induced reflux) underwent EVLA. When compressive syndrome was suspected, pre-procedural CT venography was obtained. Procedures used local anesthesia with conscious sedation via right basilic access. A 400-μm, 1470-nm radial fiber delivered 6-8 W with controlled pullback targeting proximal/mid gonadal vein segments. Diagnostic venography of the left renal, left common iliac, and internal iliac veins ruled out compression and mapped reflux/varices; the ureter was identified fluoroscopically for safety.

technical success (cessation of reflux/closure on completion venography and 3-month CT) and safety (peri-procedural complications). Secondary endpoints: same-day discharge, pain (VAS), and imaging resolution of pelvic varices.

48-h clinic visit, 4-week transvaginal Doppler, 3-month venous-phase CT, and 6-month clinical assessment.

Mean age 37 years (28-45). Baseline symptoms: pelvic pain 100%, dysmenorrhea 77%, dyspareunia 94%, postcoital pain 97%; mean VAS 7.8/10. All cases were day-case (hospital stay 0 days). Mean target-vein diameter 14 mm (10-17). All had left gonadal vein reflux (SVP S2V2; non-thrombotic). Procedure time 45-60 min; estimated blood loss ∼10 mL. No intra- or postoperative complications (no perforation, bleeding, ureteral injury, thrombosis, access issues, or contrast reactions). Technical success 100%: 3-month CT confirmed complete occlusion in 10/10 and Doppler showed resolution of pelvic varices. Pain improved rapidly (VAS 1-2/10 at 24 h) and was sustained (0.4/10 at 6 months); no opioids, readmissions, or reinterventions at 30 days. Patient-reported quality of life improved across follow-up.

Basilic-access 1470-nm EVLA of refluxing gonadal veins is feasible, safe, and shows high early technical and clinical success with same-day discharge and no complications in this pilot cohort. Larger multicenter randomized trials with ≥12-month follow-up, blinded imaging review, standardized PROs, and cost-effectiveness analyses are warranted.