TY - JOUR
T1 - Trans-venous occlusion of incompetent pelvic veins for chronic pelvic pain in women
T2 - A systematic review
AU - Hansrani, Vivak
AU - Abbas, Abeera
AU - Bhandari, Sahil
AU - Caress, Ann Louise
AU - Seif, Mourad
AU - McCollum, Charles N.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Chronic pelvic pain (CPP) affects 24% of women worldwide; the cause cannot be identified in 40% despite invasive investigations. Dilated, refluxing pelvic veins may be a cause of CPP and treatment by trans-venous occlusion is increasingly performed when gynecological causes are excluded, but is it effective? A systematic review of the literature published between 1966 and July 2014 was conducted. Two authors independently reviewed potential studies according to a set of eligibility criteria, with a third assessor available as an arbiter. Thirteen studies including 866 women undergoing trans-venous occlusion of pelvic veins for CPP were identified (Level of evidence: one study grade 2b, 12 studies grade four). Statistical significant improvements in pelvic pain were reported in nine of the 13 studies. Technical success was reported in 865 of 866 (99.8%) with low complication rates: coil migration in 14 women (1.6%), abdominal pain in ten women (1.2%) and vein perforation in five (0.6%). In a study on varicose veins of the legs, recurrence was seen in 13% of 179 women 5-years following coil embolization. Subjective improvements in pain were seen in all 13 studies after treatment by trans-venous occlusion. All 13 studies were of poor methodological quality. Complication rates were low and no fatalities occurred. Well-designed studies are essential to determine whether pelvic vein incompetence (PVI) is associated with CPP, and to explore whether trans-venous occlusion of PVI improves quality of life for these women.
AB - Chronic pelvic pain (CPP) affects 24% of women worldwide; the cause cannot be identified in 40% despite invasive investigations. Dilated, refluxing pelvic veins may be a cause of CPP and treatment by trans-venous occlusion is increasingly performed when gynecological causes are excluded, but is it effective? A systematic review of the literature published between 1966 and July 2014 was conducted. Two authors independently reviewed potential studies according to a set of eligibility criteria, with a third assessor available as an arbiter. Thirteen studies including 866 women undergoing trans-venous occlusion of pelvic veins for CPP were identified (Level of evidence: one study grade 2b, 12 studies grade four). Statistical significant improvements in pelvic pain were reported in nine of the 13 studies. Technical success was reported in 865 of 866 (99.8%) with low complication rates: coil migration in 14 women (1.6%), abdominal pain in ten women (1.2%) and vein perforation in five (0.6%). In a study on varicose veins of the legs, recurrence was seen in 13% of 179 women 5-years following coil embolization. Subjective improvements in pain were seen in all 13 studies after treatment by trans-venous occlusion. All 13 studies were of poor methodological quality. Complication rates were low and no fatalities occurred. Well-designed studies are essential to determine whether pelvic vein incompetence (PVI) is associated with CPP, and to explore whether trans-venous occlusion of PVI improves quality of life for these women.
KW - Chronic pelvic pain
KW - Embolization
KW - Pelvic congestion syndrome
KW - Systematic review, Pelvic vein incompetence
KW - Venous occlusion
UR - http://www.scopus.com/inward/record.url?scp=84921324816&partnerID=8YFLogxK
U2 - 10.1016/j.ejogrb.2014.12.011
DO - 10.1016/j.ejogrb.2014.12.011
M3 - Review article
C2 - 25590499
AN - SCOPUS:84921324816
VL - 185
SP - 156
EP - 163
JO - European Journal of Obstetrics, Gynecology and Reproductive Biology
JF - European Journal of Obstetrics, Gynecology and Reproductive Biology
SN - 0028-2243
ER -