Basilic vein access as an effective alternative for endovascular embolization of pelvic varicose veins: A retrospective-cohort based population study

Abstract

Objectives

Pelvic congestion syndrome (PCS), often underdiagnosed, is a cause of chronic pelvic pain in women and is frequently associated with pelvic varicose veins. Endovascular embolization is an established treatment, traditionally performed via femoral or jugular access. However, these approaches may carry higher risks of complications. This study aimed to evaluate the safety, feasibility, and clinical outcomes of using basilic vein percutaneous access for pelvic vein embolization in patients with PCS.

Methods

A retrospective cohort study was conducted on 292 women of reproductive age with symptomatic PCS who underwent pelvic varicose vein embolization using percutaneous access via the distal third of the right basilic vein. The study spanned from 2018 to 2023 and was carried out at two hospitals in Bogotá, Colombia. Inclusion criteria comprised chronic pelvic postcoital pain and Doppler-confirmed pelvic varicosities with reflux diameters >6 mm. Data collected included demographics, CEAP and Symptoms-Varices-Pathophysiology classifications, intraoperative details (access approach, duration, coil usage, complications), and postoperative outcomes (symptom resolution, complications, reintervention, ICU/hospital stay, and mortality). Follow-up evaluations were conducted at 15 days, 3 months, and 6 months post-procedure. Descriptive statistics were used for analysis. A detailed description of the surgical technique used for basilic vein access and embolization was included.

Results

All 292 procedures were successfully performed using basilic vein access with no access-related complications such as bleeding, thrombosis, or hematoma. The average surgical duration was 41.1 min (SD = 4.1), and a mean of 2.6 coils (SD = 0.7) was used per case. The left gonadal vein was embolized in all patients, with additional embolization of the right gonadal (68.8%) and hypogastric veins (6.8%) when indicated. Only one patient (0.3%) experienced a coil migration resulting in pulmonary embolism, requiring reintervention and a short ICU stay. No mortalities were reported. Symptom resolution was achieved in 278 patients (95.2%), indicating high procedural effectiveness.

Conclusions

Basilic vein access is a feasible and safe alternative for pelvic vein embolization in patients with PCS. This approach demonstrated excellent technical success, a low complication rate, and high symptom resolution, with the added benefits of shorter procedure time and reduced coil usage compared to traditional access routes. These findings suggest potential procedural and resource efficiency advantages. However, due to the study’s retrospective nature and lack of comparative controls, prospective studies are necessary to further assess the long-term efficacy and cost-effectiveness of basilic access in comparison to femoral and jugular approaches. Establishing standardized guidelines for vascular access in PCS treatment could enhance outcomes and procedural safety.

Keywords

Pelvic varicose veins pelvic congestion syndrome endovascular embolization percutaneous basilic vein access chronic pelvic pain coil embolization

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