Pelvic vein embolization using different embolic agents for the treatment of pelvic venous insufficiency: A systematic review and meta-analysis

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

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