We have previously reported that in women with pelvic venous disorders (PeVD) secondary to pelvic venous insufficiency (PVI), 56% present with an iliac stenosis and ovarian vein reflux. In women who were treated with ovarian vein embolization (OVE) followed by iliac vein stenting (IVS), only 10% reported improvement in visual analog pain scores (VAS) with OVE prior to IVS. The purpose of this investigation is to determine if women with combined disease can be treated with IVS alone.
A retrospective review of prospectively collected data at the Center for Vascular Medicine was performed. We investigated women with pelvic pain or dyspareunia secondary to combined IVS and OVR who were treated with stenting alone. Patients with pelvic and leg symptoms were excluded from the investigation. Assessments and interventions consisted of an evaluation for other causes of PeVD by a Gynecologist, pre and six month VAS scores, a complete venous duplex ultrasound, and measurements of stent type, diameter, length and ovarian vein diameters. All patients underwent diagnostic venography of their pelvic and left ovarian veins, as well as intra-vascular ultrasonography (IVUS) of their iliac veins. Ovarian vein diameters were assessed intra-operatively by venography. The presence of a pelvic reservoir was defined as the presence of pelvic varices with evidence of cross pelvic collateralization.
From May 2016 to October 2019, 89 patients with PeVD secondary to IVS and OVR were identified. Of the 89 patients, 48 had pelvic pain and/or dyspareunia VAS scores recorded at the initial assessment and 30 were available for a six month follow-up visit. Pelvic and dyspareunia VAS scores at the initial encounter and at six months in the follow up group were as follows: 6.83±3.19/4.23±3.39 vs 3.24±3.22/1.89±3.18 respectively (p≤0.01). At six months 18/30 (60%) reported complete resolution, 4/30 (13%) reported significant improvement and 8/30 (27%) reported no improvement. The average ovarian vein diameter was 6.7±2.5mm. The average stent size and length was 18.20±1.6mm/92.41±18.5 with 25 placed in the Left common iliac, 2 in the right common iliac vein and 3 placed bilaterally. Five patients required reintervention (17%) of which two were in the no improvement group: one venoplasty at one month, three additional stents between 1 and 2 months and one additional stent at 18 months.
The majority of women with pelvic pain secondary to combined IVS and OVR can be treated with iliac vein stenting alone. However, 27% of women reported no improvement in their symptoms strongly suggesting that in some women, OVR is a significant component of their pelvic symptoms.