Prevalence of gynecologic disorders in women with symptomatic pelvic venous disorders.

Introduction: The diagnosis of symptomatic pelvic venous insufficiency (PVI) in women is complicated when concomitant gynecologic disorders are present. The purpose of this investigation is to determine the prevalence of concomitant gynecologic disorders in women with a PeVD secondary to PVI and to assess the effectiveness of therapeutic interventions in women with a history of these disorders.

Methods: We retrospectively reviewed the results of 2544 women treated for symptomatic PVI, from January 2017 to March 2024. Women were divided in three groups. Pelvic pain alone, leg pain alone or combined pelvic and leg pain (mixed). Patient demographics, prevalence of concomitant gynecologic disorders, presenting symptoms, CEAP, rVCSS, pre and post visual analog pain scores (VAS), stent type, and vein territory covered were assessed.

Results: Of the 2544 women, 70 presented with pelvic pain alone, 1012 with leg pain alone and 1454 with mixed symptoms. The average age of the cohort was 52±13.8. Racial distribution was the following: 49% Caucasian, 16% African American, 11% Hispanic, 1% Asian and 23% unknown. The most common gynecologic disorders reported were hysterectomy (31%), uterine fibroids (4%), endometriosis (4.4%), ovarian cysts (2.8%) and polycystic ovaries (1.5%). Average follow-up was 2.32±2.4 years. Pre and post intervention visual analog pain (VAS) scores were the following: Pelvic (7.61±3.72/1.93±3.2), Leg (6.18±2.95/2.42±3.2) and mixed (5.72± 3.72/2.4±3.1)(p≤0.05). For women with a history of endometriosis pre and post VAS scores were the following: 6.52±3.15 and 2.5±0.6 (p≤0.05). There was no difference in pre and post VAS scores in women with a history of endometriosis compared to the other presenting symptom groups. A total of 1738 stents were placed: Pelvic (n=27), Leg (n=564) and Mixed (n=935). The most common stent diameters and lengths were 14 and 16 millimeters(mm) and 140 and 160 mm. The left common and external iliac veins were the most common vein territories covered. There were 768 reinterventions for a 25.6% reintervention rate at 25±24 months.

Conclusions: The prevalence of concomitant gynecologic disorders in women with symptomatic PVI is very low and calls into question whether or not gynecologic assessments for etiologies other than PVI are necessary. Even in women with a history of endometriosis, endovascular interventions are very successful at ameliorating pelvic and/or leg symptoms. A history of concomitant gynecologic disorders should not prevent the performance of endovascular therapies in women with symptomatic PVI.