title: Effectiveness of Embolization or Sclerotherapy of Pelvic Veins for Reducing Chronic Pelvic Pain: A Systematic Review.
abstract: OBJECTIVE
  Chronic pelvic pain (CPP) in the presence of dilated and refluxing pelvic veins is often described as pelvic congestion syndrome (PCS), although the causal relationship between pelvic vein incompetence and CPP has not been established. Percutaneous embolization is the principal treatment for PCS, with high success rates cited. This study was undertaken to systematically and critically review the effectiveness of embolization of incompetent pelvic veins.
  
  
  METHODS
  A comprehensive search strategy encompassing various terms for pelvic congestion, pelvic pain, and embolization was deployed in 17 bibliographic databases, with no restriction on study design. Methodologic quality was assessed. The quality and heterogeneity generally precluded meta-analysis. Results were tabulated and described narratively.
  
  
  RESULTS
  Twenty-one prospective case series and one poor-quality randomized trial of embolization (involving a total of 1,308 women) were identified. Early substantial relief from pain was observed in approximately 75% of women undergoing embolization, and generally increased over time and was sustained. Significant pain reductions following treatment were observed in all studies that measured pain on a visual analog scale. Repeat intervention rates were generally low. There were few data on the impact on menstruation, ovarian reserve, or fertility, but no concerns were noted. Transient pain was common following foam embolization, and there was a < 2% risk of coil migration.
  
  
  CONCLUSIONS
  Embolization appears to provide symptomatic relief of CPP in the majority of women and is safe, although the quality of the evidence is low.
authors.affiliation: Birmingham Clinical Trials Unit. Electronic address: j.p.daniels@bham.ac.uk.
authors.forename: Jane P
authors.initials: JP
authors.lastname: Daniels
authors.affiliation: Institute of Metabolism and Systems Biology, Birmingham, United Kingdom.
authors.forename: Rita
authors.initials: R
authors.lastname: Champaneria
authors.affiliation: Institute of Metabolism and Systems Biology, Birmingham, United Kingdom.
authors.forename: Laila
authors.initials: L
authors.lastname: Shah
authors.affiliation: Institute of Metabolism and Systems Biology, Birmingham, United Kingdom.
authors.forename: Janesh K
authors.initials: JK
authors.lastname: Gupta
authors.affiliation: Pelvic Pain Support Network, Poole, United Kingdom.
authors.forename: Judy
authors.initials: J
authors.lastname: Birch
authors.affiliation: Department of Radiology North Glasgow University Hospitals, Glasgow, United Kingdom.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Moss
mesh_terms: D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D004108:Dilatation, Pathologic; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D017699:Pelvic Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010388:Pelvis / Q000098:blood supply*; D012039:Regional Blood Flow; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D013577:Syndrome; D016896:Treatment Outcome; D014648:Varicose Veins / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014680:Veins / Q000473:pathology / Q000503:physiopathology; D014689:Venous Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*