Ovarian vein embolization for pelvic venous congestion syndrome in women: A retrospective analysis of a clinical case series

A. Kozhamkul; A. Saduakas; А. Berkinbay; Ye. Abilkhanov; A. Sapunov; O. Bozbayev

doi:10.37800/RM.3.2025.553

Authors

A. Kozhamkul Syzganov National Scientific Center of Surgery
A. Saduakas
А. Berkinbay
Ye. Abilkhanov
A. Sapunov
O. Bozbayev

DOI:

https://doi.org/10.37800/RM.3.2025.553

Keywords:

ovarian vein embolization, chronic pelvic pain, visual analog scale, venous reflux, endovascular treatment, pelvic venous congestion syndrome (PVCS)

Abstract

Relevance: Pelvic venous congestion syndrome (PVCS) is a chronic and often underdiagnosed vascular disorder in women of reproductive age, primarily manifested by persistent pelvic pain. Impaired venous outflow, characterized by reflux and dilatation of ovarian and pelvic veins, is considered the primary mechanism. Endovascular embolization has emerged as a safe, minimally invasive treatment that provides significant symptom relief.

The study aimed to evaluate the efficacy and safety of endovascular ovarian vein embolization in women diagnosed with pelvic venous congestion syndrome.

Materials and Methods: A retrospective analysis included 17 women (18–50 years) with clinically and radiologically confirmed PVCS who underwent ovarian vein embolization at the Syzganov National Scientific Center of Surgery (Almaty, Kazakhstan) in 2023–2024. Diagnosis was based on Doppler ultrasound, CT venography, and catheter-based phlebography. Embolization was performed using coils and sclerosing agents. Pain intensity was evaluated by the Visual Analog Pain Scale (VAPS) before and after surgery (Day 1, Day 3, 1 month, 3 months). Statistical analysis was performed using the Wilcoxon signed-rank test, with p < 0.05 considered significant.

The article also presents a clinical case of PVCS with pelvic varicose vein disease.

Results: Ovarian vein reflux (Hiromura grade II-III) was detected in 88.2% of patients, predominantly on the left side. VAPS scores decreased from a median of 6.0 (IQR 5-7) preoperatively to 2.0 (IQR 1-3) at 3 months (p < 0.001). No major peri- or post-procedural complications occurred. Three women (17.6%) required re-embolization due to contralateral reflux. Overall, 82.4% of patients reported partial or complete symptom resolution.

Conclusions: Endovascular ovarian vein embolization is a safe and effective treatment for PVCS, resulting in long-term reductions in pelvic pain and improvements in quality of life. Integration of multidisciplinary diagnostic criteria and SVP classification may further optimize patient selection and outcomes.

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