Pelvic vein embolization using different embolic agents for the treatment of pelvic venous insufficiency: A systematic review and meta-analysis.
Felix Strobl, Agnes Klara Böhm, Lorenz Mertens et al.
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In 30 seconds
This systematic review and meta-analysis compared embolic agents for pelvic vein embolization in women treated for pelvic venous insufficiency. It included 28 studies, comprising 2688 patients across 34 cohorts, grouped into five treatment categories. Technical success was 98.6% to 100%, and all approaches were associated with reduced pain. Pain reduction ranged from 4.67 (95% CI, 3.87-5.47) points with sclerosant alone to 6.12 (95% CI, 5.46-6.78) with vascular plugs. The authors caution that small samples and lack of between-group comparisons limit conclusions about which agent is preferable.
Key findings
- Technical success ranged from 98.6% to 100% across embolization methods; clinical success ranged from 68.3% to 100%.
- VAS pain reduction ranged from 4.67 (95% CI, 3.87-5.47) points with sclerosant alone to 6.12 (95% CI, 5.46-6.78) with vascular plugs.
- Device migration-related complications were most frequent with coils at 2.63% (95% CI, 1.76-3.78) and least frequent with sclerosant alone at 0.45% (95% CI, 0.01-2.48).
- Vascular plugs had 0.6% complications (95% CI, 0.07-2.15), 3.47% recurrence (95% CI, 1.6-6.49), and 2.59% reintervention (95% CI, 1.12-5.04).
Why it matters
The review indicates that several embolic approaches can achieve high technical success and reduce pelvic pain, while their reported complication, recurrence, and reintervention profiles differ. These pooled findings can inform discussion of procedural options, but they do not establish comparative superiority because the evidence lacks direct between-group comparisons and the authors advise caution.
What to keep in mind
The authors note small sample sizes and lack of inter-group comparisons, limiting confidence in comparisons between embolic agents.