Pelvic Vein Embolization using different Embolic Agents for the Treatment of Pelvic Venous Insufficiency: A Systematic Review and Meta-Analysis.

Authors

Felix Strobl, Agnes Klara Böhm, Lorenz Mertens, Maximilian de Bucourt, Jan Paul Frese, Houman Jalaie, Andreas Greiner, Leon Bruder

Published in

Journal of vascular surgery. Venous and lymphatic disorders. Pages 102599. Aug 09, 2026. Epub Aug 09, 2026.

Abstract

Embolization of insufficient pelvic veins has established itself as the standard first-line therapy in women suffering from chronic pain due to pelvic venous disorder, however clinically established embolic devices vary widely with coils, vascular plugs, glue, sclerosants or combinations of the above presenting as the most common. This study aims to evaluate different devices' ability to reduce pain and evaluate their individual rates of success and complications.
A systematic search was conducted on PubMed, ScienceDirect, Cochrane and ClinicalTrials.gov for studies published on embolization of insufficient pelvic veins up until November 2025. Primary outcome measure was effect on pelvic pain as measured by visual analog scale (VAS). Secondary endpoints were technical and clinical success as well as recurrence, complication and reintervention.
A total of 28 studies met inclusion criteria, totaling 2688 patients across 34 individual cohorts that were grouped into treatment categories. Technical success was high across all embolization methods with ranges of 98.6 - 100%, while clinical success ranged from 68.3 - 100%. All endovascular treatment options led to a reduction in pain as measured by VAS ranging from 4.67 (95% CI 3.87 to 5.47) points reduction in the sclerosant only group to 6.12 (95% CI 5.46 to 6.78) in the vascular plugs group. Clinical success was reported highest in sclerosant only and plug groups at 97.5% (95% CI 93.7 to 99.3) and 94.7% (95% CI 86.9 to 98.5) respectively. Complications, especially in the form of device migration, most frequently appeared in the coils group at 2.63% (95% CI 1.76 to 3.78) and least frequently in the sclerosant only group at 0.45% (95% CI 0.01 to 2.48). Sclerosant only showed the lowest recurrence at 1.69% (95% CI 0.49 to 4.87) however highest number of reinterventions at 13.3% (95% CI 5.1 to 26.8). Vascular plugs showed few complications (0.6% [95% CI 0.07 to 2.15]), as well as low recurrence (3.47% [95% CI 1.6 to 6.49]) and reintervention (2.59% [95% CI 1.12 to 5.04]).
All embolization methods show excellent technical success and marked reduction in pain as measured by VAS. Using coils seems to be associated with highest occurrence of device migration. The vascular plugs and the sclerosant groups show high clinical success with low complication rates. Due to small sample sizes and lack of inter-group comparisons, conclusions should be viewed cautiously.

PMID:
42571790
Bibliographic data and abstract were imported from PubMed on 10 Aug 2026.

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