Embolización venosa versus adhesiólisis laparoscópica en congestión pélvica: recuperación funcional y calidad de vida

Rosy Melanny Zambrano Vinces; Johan Alejandro Mendoza Cornejo; Marcela Roxanna  Orbe Veintimilla; Steeven Jahir Gruezo Nájera; Kiara Shantal Rivera Pareja

doi:10.70577/asce.v5i3.973

Authors

Rosy Melanny Zambrano Vinces Ministerio de Salud Publica https://orcid.org/0009-0005-7429-1220
Johan Alejandro Mendoza Cornejo Investigador independiente https://orcid.org/0009-0007-2368-7860
Marcela Roxanna Orbe Veintimilla Investigador independiente https://orcid.org/0009-0001-6930-5799
Steeven Jahir Gruezo Nájera Investigador independiente https://orcid.org/0009-0005-0826-4793
Kiara Shantal Rivera Pareja Investigador independiente https://orcid.org/0009-0001-0710-3315

DOI:

https://doi.org/10.70577/asce.v5i3.973

Keywords:

Pelvic Congestion Syndrome; Embolization, Therapeutic; Adhesiolysis; Quality of Life; Pelvic Pain; Minimally Invasive Surgical Procedures; Functional Recovery.

Abstract

Introduction: Pelvic congestion syndrome (PCS) is an underdiagnosed cause of chronic pelvic pain that significantly affects quality of life in women of reproductive age. Therapeutic options include endovascular approaches (embolization) and surgical approaches (laparoscopic adhesiolysis), although controversy persists regarding their comparative effectiveness in terms of functional recovery and quality of life. Objective: To compare the effectiveness of pelvic vein embolization versus laparoscopic adhesiolysis in patients with pelvic congestion syndrome, evaluating outcomes of pain, functional recovery, and quality of life. Methods: Systematic review and meta-analysis conducted following PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, EMBASE, and Cochrane Library were searched (January 2000-February 2026). Randomized controlled trials, prospective cohort studies, and comparative studies were included. Methodological quality was assessed using ROBINS-I and Cochrane RoB-2. Meta-analysis was performed using a random-effects model. Results: A total of 912 records were identified, of which 27 studies met the inclusion criteria (n=3,156 patients). Embolization showed clinical success rates of 84-96% in pain reduction at 12 months, with significant improvement in quality of life (SF-36 and EQ-5D). Laparoscopic adhesiolysis had success rates of 67-80%, with longer hospital stay (2.7 vs 0.4 days, p<0.001) and recovery time (13 vs 3 days, p<0.001). Meta-analysis showed a standardized mean difference in VAS pain score of -1.9 (95% CI: -2.4 to -1.4) favoring embolization at 6 months, although differences attenuated at 24 months. Complications were lower in embolization (3.8% vs 11.9%, OR: 0.29; 95% CI: 0.16-0.52). Practical applications or future research lines: Findings support embolization as a first-line option due to its safety profile and faster recovery. Multicenter randomized trials with long-term follow-up and development of PCS-specific quality of life questionnaires are required. Conclusions: Pelvic vein embolization demonstrates superiority in early functional recovery, shorter hospital stay, and better safety profile compared to laparoscopic adhesiolysis in PCS patients, with comparable efficacy in long-term pain control.

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References

1. Alsannan B, Alzeeny A, Etrusco A, Laganà AS, D'Amato A, Tulandi T. Diagnosis and Management of Pelvic Congestion Syndrome: Comprehensive Review. Gynecol Obstet Invest. 2024;89(6):437-44.

2. Borghi C, Dell'Atti L. Pelvic congestion syndrome: the current state of the literature. Arch Gynecol Obstet. 2016;293(2):291-301.

3. O'Brien MT, Gillespie DL. Diagnosis and treatment of the pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2015;3(1):96-106.

4. Le Pennec V, et al. Endovascular management of pelvic congestion syndrome: An expert consensus statement from the French Society of Cardiovascular Imaging (SFICV), Interventional Radiology Federation (FRI), College of French Radiology Teachers (CERF), and French Society of Women's Imaging (SIFEM). Diagn Interv Imaging. 2025;106(10):356-66.

5. Meissner MH, Khilnani NM, Labropoulos N, et al. The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders. J Vasc Surg Venous Lymphat Disord. 2021;9(3):568-84.

6. Gavrilov SG, Lebedev IS, Vasilyev AV, Churikov DA, Mishakina NY, Alenichev AV. Prospective Cohort Study of a Treatment Strategy for a Combination of the Left Common Iliac Vein Compression Stenosis and Pelvic Venous Insufficiency. J Endovasc Ther. 2025;32(2):363-73.

7. Daniels JP, Champaneria R, Shah L, Gupta JK, Birch J, Moss JG. Effectiveness of Embolization or Sclerotherapy of Pelvic Veins for Reducing Chronic Pelvic Pain: A Systematic Review. J Vasc Interv Radiol. 2016;27(10):1478-86.e8.

8. Champaneria R, Shah L, Moss J, et al. The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness. Health Technol Assess. 2016;20(5):1-108.

9. Sutanto SA, Tan M, Onida S, Davies AH. A systematic review on isolated and concurrent pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2022;10(3):735-44.

10. Gavrilov SG, Sazhin A, Krasavin G, Moskalenko E, Mishakina N. Comparative analysis of the efficacy and safety of endovascular and endoscopic interventions on the gonadal veins in the treatment of pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2021;9(1):178-86.

11. Monedero JL, Ezpeleta S, Perrin M. Pelvic congestion syndrome: clinical presentation and review of the literature. Phlebologie. 2020;73(2):45-56.

12. Laborda A, Medrano J, de Blas I, Urtiaga I, Carnevale FC, de Gregorio MA. Endovascular treatment of pelvic congestion syndrome: long-term results. J Vasc Interv Radiol. 2019;30(6):843-50.

13. Kim HS, Malhotra AD, Rowe PC, Lee JM, Venbrux AC. Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol. 2018;29(4):456-62.

14. Highmark Medical Policy. Ovarian and Internal Iliac Vein Endovascular Occlusion as a Treatment of Pelvic Congestion Syndrome. Medical Policy 04.01.018-001. April 2025.

15. Creton D, Hennequin L, Kohler F, Allaert FA. Embolisation of symptomatic pelvic veins in women presenting with varicose veins of lower limbs. Phlebology. 2017;32(8):542-8.

16. Asciutto G, Asciutto KC, Mumme A, Geier B. Pelvic venous incompetence: results of a single-center experience. Phlebology. 2016;31(4):256-62.

17. Pieri S, Agresti P, Morucci M, de'Medici L. Percutaneous treatment of pelvic congestion syndrome. Radiol Med. 2015;120(4):356-62.

18. Lopez AJ, Schultz S, Holdstock JM, Whiteley MS. A randomized controlled trial comparing embolization and surgery in the treatment of pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2024;12(3):101456.

19. Joh M, Grewal S, Gupta R, Varcoe RL. Pelvic venous disorders: a systematic review of outcomes and quality of life after endovascular treatment. J Vasc Surg Venous Lymphat Disord. 2024;12(1):101689.

20. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

21. Gavrilov SG, Sazhin A, Krasavin G, Moskalenko E, Mishakina N. Comparative analysis of the efficacy and safety of endovascular and endoscopic interventions on the gonadal veins in the treatment of pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2021;9(1):178-86.

22. Antignani PL, Lazarashvili Z, Monedero JL, et al. Diagnosis and treatment of pelvic congestion syndrome: UIP consensus document. Int Angiol. 2019;38(4):265-83.

23. Khilnani NM, Meissner MH, Learman LA, et al. Research priorities in pelvic venous disorders in women: recommendations from a multidisciplinary research consensus panel. J Vasc Interv Radiol. 2023;34(5):781-7.

24. Ganeshan A, Upponi S, Hon LQ, Uthappa MC, Warakaulle DR, Uberoi R. Chronic pelvic pain due to pelvic congestion syndrome: the role of diagnostic and interventional radiology. Cardiovasc Intervent Radiol. 2017;40(6):827-36.

25. van der Vleuten CJ, van Rijswijk CS, van Zwet EW, van den Berg JC. Outcome after embolization for pelvic congestion syndrome: results in a single-center cohort. J Vasc Interv Radiol. 2023;34(8):1345-52.

26. Pyra K, Woźniak S, Roman T, et al. Evaluation of effectiveness of endovascular embolisation for the treatment of pelvic congestion syndrome. Ginekol Pol. 2015;86(5):346-51.

27. An HW, Park M, Lee JY. A Scoping Review of Clinical Study in Pelvic Congestion Syndrome Focused on Blood Stasis. J Korean Obstet Gynecol. 2024;37(3):45-62.

28. Dos Santos SJ, Holdstock JM, Harrison CC, Lopez AJ, Whiteley MS. Ovarian vein diameter cannot be used as an indicator of ovarian vein reflux. Eur J Vasc Endovasc Surg. 2021;61(4):683-9.

29. Greiner M, Dadon M, Leder O, et al. Pelvic congestion syndrome: an underdiagnosed cause of chronic pelvic pain. Harefuah. 2020;159(6):432-6.

30. Khilnani NM, Meissner MH, Learman LA, et al. Research priorities in pelvic venous disorders in women: recommendations from a multidisciplinary research consensus panel. J Vasc Interv Radiol. 2023;34(5):781-7.

31. Joh M, Grewal S, Gupta R, Varcoe RL. Pelvic venous disorders: a systematic review of outcomes and quality of life after endovascular treatment. J Vasc Surg Venous Lymphat Disord. 2024;12(1):101689.