Introduction: The diagnosis of symptomatic pelvic venous disorders in women is complicated when concomitant gynecologic disorders are present. The prevalence of gynecologic disorders in women with symptomatic pelvic venous insufficiency (PVI) and the effectiveness of endovascular intervention is currently ill defined. The purpose of this investigation is to determine the prevalence of concomitant gynecologic disorders and to assess the effectiveness of therapeutic interventions in a subset of women with a history of endometriosis.
Methods: We retrospectively reviewed the results of 2544 women treated for symptomatic PVI, from January 2017 to March 2024. Women were divided in three groups. Pelvic pain alone, leg pain alone or combined pelvic and leg pain (mixed). Patient demographics, prevalence of concomitant gynecologic disorders, presenting symptoms, CEAP, rVCSS, pre and post visual analog pain scores (VAS), stent type, vein territory covered and reintervention rates were assessed.
Results: Of the 2544 women, 70 presented with pelvic pain, 1012 with leg pain and 1454 with combined pelvic and leg pain. The average age of the cohort was 56. Racial distribution was the following: 49% Caucasian, 16% African American, 11% Hispanic, 1% Asian and 23% unknown. The most common gynecologic disorders reported were uterine fibroids (4%), endometriosis 44%, ovarian cysts 2.8%, polycystic ovaries 1.5%. Average follow-up was 2.32±2.4 years. Pre-op VAS scores were the following: Pelvic (7.61 ± 3.72), Leg (6.18 ± 2.95) and mixed (5.72 ± 3.72). For women with a history of endometriosis Pre and post VAS scores were the following: (6.98 ± 3.29) and (5.75 ± 3.25). The average between procedure date and the latest follow up for the Endometriosis patients is 28 months. A total of 1738 stents were placed: Pelvic (n=27), Leg (n=564) and Mixed (n=935). The most common stent diameters and lengths were 14 and 16 millimeters(mm) and 140 and 160 mm. The left common and external iliac veins were the most common vein territories covered. There were 215 reinterventions for a 12.5% reintervention rate. Twenty-three percent were ipsilateral to the index stent, 68% were for new contralateral iliac vein stenoses and 9% were for ipsilateral and contralateral lesions. There was total 27 patients with history of Abdominal hysterectomy.
Conclusions: The prevalence of concomitant gynecologic disorders in women with symptomatic PVI is very low and calls into question whether or not gynecologic assessments for etiologies other than PVI are necessary. Even in women with a history of endometriosis, endovascular interventions are very successful at ameliorating pelvic and/or leg symptoms. A history of concomitant gynecologic disorders should not prevent women from therapeutic interventions for the treatment of their symptomatic PVI.
