Trans-venous occlusion of incompetent pelvic veins for chronic pelvic pain in women: a systematic review

Vivak Hansrani, Abeera Abbas, Sahil Bhandari, Ann-Louise Caress, Mourad Seif, Charles N Mccollum

Research output: Contribution to journalArticlepeer-review


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 gynaecological 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 embolisation. 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.
Original languageEnglish
Pages (from-to)156-163
Number of pages7
JournalEuropean Journal of Obstetrics & Gynecology and Reproductive Biology
Publication statusPublished - 1 Feb 2015


  • systematic review
  • pelvic vein incompetence
  • embolisation
  • chronic pelvic pain
  • pelvic congestion syndrome
  • venous occlusion


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