In a meta-analysis of 21 prospective case series involving a total of 1,308 women, early substantial pain relief was observed in 75% of women undergoing embolization (including combinations of coil, glue, and sclerotherapy), generally increasing and sustained over time. Repeat interventions were generally low, and, although there were few data on post-treatment impact on menstruation, ovarian reserve, and fertility, no concerns were noted. Overall, transient pain was common following foam embolization, and there was <2% risk of coil migration. Overall, data from studies that used a sclerosant suggest significant symptomatic improvement of approximately 75% [59]. Foam sclerotherapy has also shown good results as an alternative to embolization in patients with leg, vulvar, and pudendal varicosities of pelvic origin without pelvic venous disease [60]. Iliac Vein Stenting There is no relevant literature regarding the use of iliac stenting in the treatment of pelvic-origin lower extremity varicose veins in women, although it is postulated that stenting may relieve the congestion in the pelvis. However, there is no high-quality data. Iliac Vein Embolization Internal iliac vein embolization (in addition to ovarian vein embolization) has been shown to be safe and effective in treating pelvic venous insufficiency and reducing pelvic pain in most women undergoing treatment for pelvic congestion syndrome [61]. However, there is no high-quality data demonstrating the value of pelvic embolization or iliac or renal vein stenting to improve pelvic origin varicose veins and their related symptoms. Iliac Vein Surgery There is no relevant literature regarding the use of iliac vein surgery in the treatment of pelvic-origin lower extremity varicose veins in women. Left Renal Vein Stenting The treatment of pelvic venous disease due to nutcracker syndrome has been primarily surgical in the past, employing left renal vein bypass, transposition, and external stent placement.
Lower Extremity Chronic Venous Disease. In a meta-analysis of 21 prospective case series involving a total of 1,308 women, early substantial pain relief was observed in 75% of women undergoing embolization (including combinations of coil, glue, and sclerotherapy), generally increasing and sustained over time. Repeat interventions were generally low, and, although there were few data on post-treatment impact on menstruation, ovarian reserve, and fertility, no concerns were noted. Overall, transient pain was common following foam embolization, and there was <2% risk of coil migration. Overall, data from studies that used a sclerosant suggest significant symptomatic improvement of approximately 75% [59]. Foam sclerotherapy has also shown good results as an alternative to embolization in patients with leg, vulvar, and pudendal varicosities of pelvic origin without pelvic venous disease [60]. Iliac Vein Stenting There is no relevant literature regarding the use of iliac stenting in the treatment of pelvic-origin lower extremity varicose veins in women, although it is postulated that stenting may relieve the congestion in the pelvis. However, there is no high-quality data. Iliac Vein Embolization Internal iliac vein embolization (in addition to ovarian vein embolization) has been shown to be safe and effective in treating pelvic venous insufficiency and reducing pelvic pain in most women undergoing treatment for pelvic congestion syndrome [61]. However, there is no high-quality data demonstrating the value of pelvic embolization or iliac or renal vein stenting to improve pelvic origin varicose veins and their related symptoms. Iliac Vein Surgery There is no relevant literature regarding the use of iliac vein surgery in the treatment of pelvic-origin lower extremity varicose veins in women. Left Renal Vein Stenting The treatment of pelvic venous disease due to nutcracker syndrome has been primarily surgical in the past, employing left renal vein bypass, transposition, and external stent placement.