Loading ...

Data from a series of women suggest that a resorbable polymer is an effective embolization agent for female pelvic varicose veins. This therapeutic strategy appears to improve quality of life in patients with pelvic venous disease, which is a cause of chronic pelvic pain.

The prospective and multidisciplinary research, which was recently published in the European Journal of Vascular and Endovascular Surgery, was led by experts from the University Clinic of Navarra, Pamplona, Spain.

José Ignacio Leal, a specialist in the Vascular Surgery Department of the University Clinic of Navarra and lead author of the research, told the Medscape Spanish edition that this pathology is common and underdiagnosed. Unfortunately, there are no population studies on its prevalence, at least in Spain, he said.

"For this reason, we cannot have an exact idea of how many people we are referring to. There are data in the United States suggesting that up to 15% of women between ages 20 and 50 years have different degrees of pelvic venous disease. If we take into account all women with chronic pelvic pain, we are talking about practically half of them being caused by pelvic venous disease."

Leal clearly identified two types of women with this condition who could benefit from the new technique. "The most frequent and also the most typical in our environment, and the one we most commonly treat, are women who have had several pregnancies, specifically two or more, in very young women who have had pregnancies that were close together in time and who present a lot of varicose veins."

The second pattern, which may be less common, according to the specialist, is that of the young woman with chronic pelvic pain who has had discomfort for many years, "which has been identified as pelvic floor muscle pathology or gynecological pathology or has not been identified at all. In these cases, with targeted study, we can determine that there is a venous component."

To explain why this common condition is underdiagnosed, Leal pointed out that its prevalence is the main obstacle to diagnosis. "The fact that it is such a common condition that all gynecologists see in multiparous women with several pregnancies, and because it is practically constant in certain profiles of women (with many or closely spaced pregnancies), it is overlooked. The truth is that one-third of patients with varicosity around the uterus have suggestive symptoms."

Polymer vs Coils

Another factor contributing to underdiagnosis is that the symptoms (such as pain during intercourse or menstrual pain) involve the sexual sphere, "which many women consider normal, making them live with a level of chronic pain that is more or less tolerable. They may not even realize the improvement until that pain has disappeared when the varicose veins are treated."

"One of the fundamental points we consider, at a departmental and institutional level, when managing these patients, is that we are treating a group of very young women, and it is very important not to leave definitive implants in their circulation," Leal explained.

The traditional approach to female pelvic varicose veins consists of closing the affected vessels using coils (minimally invasive implants of an exogenous material, usually metal alloys).

"We know that coils generate a thrombotic effect in that area, preventing blood from passing again, but we do not know the long-term effect of this material. This is a key issue, since we are talking about very young women who will live an average of 30-40 more years. Hence, it would be important to enable the natural healing of the treated vessel without leaving definitive implants inside."

Leal outlined the specific advantages of using a resorbable polymer as an embolization agent for varicose veins compared with other techniques and materials. "Compared with traditional treatment, the main advantage…is that it allows us to treat the vein completely without leaving a definitive implant, since the polymer is reabsorbed. Likewise, regarding other techniques, especially embolization and liquids (which we also use), there seems to be a pattern of less post-procedure inflammation, which allows women to recover much earlier and resume their daily activities almost immediately. Nevertheless, this aspect of the ongoing study is currently under evaluation."

To what extent can this approach relieve the chronic pain caused by pelvic venous disease? "We have observed an improvement in scoring scales (which include symptoms of the circulatory, gynecological, and sexual spheres) in all treated patients," said Leal. "Considering our entire historical series, more than 90% of our patients respond significantly to treatment."

Multidisciplinary Approach

This technique has a positive impact on the quality of life in two ways. "The first is that the procedure, as we perform it, through a puncture in the arm and on an outpatient basis, allows women to return to their usual life from the very beginning, without any activity limitations, as it does not require hospitalization," said Leal. "The second, given that it is a polymer that does not generate an inflammatory reaction, is that there is no postoperative pain."

Furthermore, this technique involves the interaction of three medical specialties: Vascular surgery, interventional surgery, and gynecology.

"The fact that the same interdisciplinary team is present and perfectly integrated, from diagnosis to intervention in the hybrid operating room, ensures the consistency of the entire therapeutic process," said Alberto Alonso, an interventional radiology specialist at the University Clinic of Navarra and coauthor of the publication.

"The way our unit has worked, since its inception in 2017, has always been based on the multidisciplinary approach and the assessment of the various specialties' viewpoints on each specific case. In fact, embolization and the management of pelvic congestion syndrome were the starting points for the teamwork of our unit," said Alonso.

"The study underscores the idea that excellence in managing a patient with pelvic venous disease must be framed within the context of a unit that includes diagnosis before and after the procedure and the procedure itself," Alonso added. This team approach is the way forward, he said, "and should be standard practice not only in women but in all patients, as it puts them at the center of care."

Durability

The University Clinic of Navarra investigators described their protocol for patients with pelvic varicose veins in a 2021 paper. Since then, they have developed an extensive line of research in the field, describing approaches to the embolization of pelvic venous disease to improve the associated symptoms through minimally invasive procedures without using implants.

The researchers plan to use the resorbable polymer technique for other issues related to pelvic venous disease or similar pathologies, said Leal.

"The most immediate step is to confirm the durability of this technique in the medium and long terms," he added. "The experience we have reported is preliminary. We described this technique and demonstrated that it is possible to use this material with excellent results at 30 days and with quality image control (ie, MRI), which demonstrates the effectiveness of the procedure. Later, it will be necessary to confirm that the clinical results at 1 year are the same.

"Also, the fact that we are increasing the number of treated patients has encouraged the gathering of more scientific evidence. Our group has opted for this technology (which already is used in other areas, especially in the aortic area, in the embolization of vascular malformations) and will continue to do so, as we consider it an extremely promising option," Leal concluded.

Leal and Alonso reported having no relevant financial relationships.

This story was translated from the Medscape Spanish edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.