Management of pelvic venous disorders

Patients with pelvic congestion syndrome, which is the part of pelvic venous disorders (PeVDs), present with unexplained chronic pelvic pain greater than six months, and anatomical findings including pelvic venous insufficiency and pelvic varicosities. Venography is usually necessary to confirm ovarian vein reflux and should be the first step of embolization. Endovascular therapy has been validated by several large patient series with long-term follow-up and should be the first-line therapy. Embolization has been shown to be significantly more effective than surgical therapy in improving symptoms in patients who fail hormonal therapy. Briefly, the goal is to eliminate the ovarian vein reflux with direct sclerosis or embolization of enlarged pelvic varicosities. Symptom improvement is seen in 70 to 90% of the treated patients, despite technical variation. Different embolic agents can be used for this purpose. Therefore, in this review, we discuss the different types of treatment available, with focus on embolic materials.