title: Trans-venous occlusion of incompetent pelvic veins for chronic pelvic pain in women: a systematic review.
abstract: 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.
authors.affiliation: Department of Academic Surgery, Institute of Cardiovascular Sciences, University Hospitals of South Manchester NHS Trust, Southmoor Road, Manchester M23 9LT, UK. Electronic address: Vivak.hansrani@manchester.ac.uk.
authors.forename: Vivak
authors.initials: V
authors.lastname: Hansrani
authors.affiliation: Department of Academic Surgery, Institute of Cardiovascular Sciences, University Hospitals of South Manchester NHS Trust, Southmoor Road, Manchester M23 9LT, UK. Electronic address: Abeera.abbas@manchester.ac.uk.
authors.forename: Abeera
authors.initials: A
authors.lastname: Abbas
authors.affiliation: Department of Academic Surgery, Institute of Cardiovascular Sciences, University Hospitals of South Manchester NHS Trust, Southmoor Road, Manchester M23 9LT, UK. Electronic address: sahil.bhandari@student.manchester.ac.uk.
authors.forename: Sahil
authors.initials: S
authors.lastname: Bhandari
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Room 6.341, Jean McFarlane Building, Manchester M13 9PL, UK. Electronic address: ann.caress@manchester.ac.uk.
authors.forename: Ann-Louise
authors.initials: AL
authors.lastname: Caress
authors.affiliation: Institute of Cancer Sciences, University of Manchester, 5th Floor, Research Floor, St. Mary's Hospital, Manchester M13 9WL, UK. Electronic address: mwseif@manchester.ac.uk.
authors.forename: Mourad
authors.initials: M
authors.lastname: Seif
authors.affiliation: Institute of Cardiovascular Sciences, University of Manchester, Academic Surgery Unit, 2nd Floor, Education and Research Centre, University Hospital of South Manchester, Manchester M23 9LT, UK. Electronic address: charles.mccollum@manchester.ac.uk.
authors.forename: Charles N
authors.initials: CN
authors.lastname: McCollum
mesh_terms: D002908:Chronic Disease; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D017699:Pelvic Pain / Q000628:therapy*
keywords: Chronic pelvic pain; Embolization; Pelvic congestion syndrome; Systematic review, Pelvic vein incompetence; Venous occlusion