Pelvic venous reflux embolization in the treatment of symptomatic pelvic congestive syndrome: a systematic review with meta-analysis

Objective: The objective of this study was to objectively evaluate the improvement of chronic pelvic pain in patients with congestive pelvic syndrome undergoing pelvic venous embolization treatment through the Visual Analog Scale (VAS) measurement.Methods: This is a meta-analysis conducted by evaluating descriptors indexed in the Medical Subject Heading platform and variable terms in the following databases: PubMed, ScienceDirect, LILACS, Cochrane Library, and CINAHL up until March 2021. The study was registered in the PROSPERO platform with reference number CRD42021246488. Results: A total of 1426 patients (age range, 31-49 years; 100% female), included in 19 studies (range, 11-520 patients), met the inclusion criteria. All studies showed a decrease in mean VAS scores after pelvic venous embolization (P < .001). There was a reduction of 5.15 points (95% confidence interval [CI], 4.44-5.86; I2 = 97%) in VAS considering a meta-analysis with random effects. Dyspareunia, dysuria, and dysmenorrhea symptoms improved in 79.8% (n = 401), 77.3% (n = 205), and 46.7% (n = 303) of symptomatic patients, respectively. Studies that evaluated associated symptoms through the VAS also reported a decrease in mean scores for dyspareunia (1.8 points; 95% CI, 1.07-2.53; I2 = 0%), dysuria (1.63 points; 95% CI 0.84-2.41; I2 = 0%), and dysmenorrhea (2.7 points; 95% CI 1.87-3.53; I2 = 0%). The procedure was mostly performed in gonadal and hypogastric veins (72.5%), followed by left ovarian vein alone (18.7%) and bilateral gonadal veins (7%). Embolizing agents used were coils and/or vascular plugs (76.5%), liquid (4%), or combined (19.4%) agents, with clinical improvement maintained during a mean follow-up period of 21.7 months. Regarding recurrence of symptoms, pelvic pain was the most reported, with 52 recurrences (6.1%) in a mean time of 8.5 to 21 months, followed by lower limb varicosities with 43 recurrences (16.6%). Coil migration was the most common major complication with 29 occurrences (2%), followed by thrombosis with one occurrence (0.07%).Conclusions: Pelvic venous embolization is efficient in reducing chronic pelvic pain secondary to the symptomatic pelvic congestive syndrome and its related symptoms objectively evaluated by the VAS. Studies with greater follow-up that promote comparison between techniques to treat symptomatic patients are required. (J Vasc Surg Venous Lymphat Disord 2023;11:412-21.)