Abstract
BACKGROUND: Pelvic venous disorders causing pelvic congestion syndrome are a common, underdiagnosed source of chronic pelvic pain. Standard coil/sclerosant embolization may be limited by migration, incomplete occlusion, postembolization syndrome, symptom recurrence, and cost. Endovenous thermal ablation (EVLA) could provide precise, device-free closure with faster recovery and lower cost. OBJECTIVE: We evaluated the feasibility, safety, and early efficacy of basilic access 1470-nm EVLA for refluxing gonadal veins in women with pelvic venous disorders. METHODS: Prospective, single-center descriptive cohort study (January to June 2025). Ten women (aged 18-50 years) with chronic pelvic pain refractory to conservative therapy and Doppler-confirmed pelvic varices (venous diameter >6 mm, low-flow waveforms, or Valsalva-induced reflux) underwent EVLA. When compressive syndrome was suspected, preprocedural computed tomography (CT) venography was obtained. Procedures used local anesthesia with conscious sedation via right basilic access. A 400-μm, 1470-nm radial fiber delivered 6 to 8 W with controlled pullback targeting proximal/mid gonadal vein segments. Diagnostic venography of the left renal, left common iliac, and internal iliac veins ruled out compression and mapped reflux/varices; the ureter was identified fluoroscopically for safety. Primary end points were technical success (cessation of reflux/closure on completion venography and 3-month CT) and safety (periprocedural complications). Secondary end points include same-day discharge, pain (visual analog scale [VAS]), and imaging resolution of pelvic varices. The follow-up protocol consisted of a 48-hour clinic visit, 4-week transvaginal Doppler ultrasound examination, 3-month venous-phase CT, and 6-month clinical assessment. RESULTS: The mean patient age was 37 years (range, 28-45 years). Baseline symptoms were pelvic pain in 100%, dysmenorrhea in 77%, dyspareunia in 94%, and postcoital pain in 97%; the mean VAS 7.8 out of 10.0. All cases were day-case (hospital stay 0 days). The mean target vein diameter was 14 mm (range, 10-17 mm). All patients had left gonadal vein reflux (Symptoms-Varices-Pathophysiology S2V2; nonthrombotic). The procedure time was 45 to 60 minutes and estimated blood loss was approximately 10 mL. No intraoperative or postoperative complications occurred (no perforation, bleeding, ureteral injury, thrombosis, access issues, or contrast reactions). Technical success was 100%; 3-month CT scans confirmed complete occlusion in 10 of the 10 patients, and Doppler ultrasound examination showed resolution of pelvic varices. Pain improved rapidly (VAS 1-2 out of 10 at 24 hours) and was sustained (0.4 out of 10 at 6 months); there were no opioid use, readmissions, or reinterventions at 30 days. Patient-reported quality of life improved across follow-up. CONCLUSIONS: Basilic access 1470-nm EVLA of refluxing gonadal veins is feasible, safe, and shows high early technical and clinical success with same-day discharge and no complications in this pilot cohort. Larger multicenter randomized trials with follow-up beyond 12 months, blinded imaging review, standardized patient-reported outcomes, and cost-effectiveness analyses are warranted.