Transvenous occlusion of incompetent pelvic veins to treat chronic pelvic pain in women: A randomised controlled trial

Abstract

Objective: To investigate the effectiveness of transvenous occlusion of incompetent pelvic veins in women presenting with chronic pelvic pain (CPP) in improving symptoms and quality of life. Design: Patient-blinded randomised controlled trial with objective outcome measures. Results were analysed on an intention-to-treat basis. Setting: Gynaecology and Vascular Surgery Services of two teaching hospitals in northwest England. Population: Sixty women aged 18–54 years presenting with CPP after exclusion of other pathology, and who were found to have pelvic vein incompetence. Methods: Participants were randomised and assigned to contrast venography alone or contrast venography plus transvenous occlusion of the incompetent pelvic veins. Main outcome measure: The primary outcome was change in pain score measured using the short-form McGill Pain Score (SF-MPQ) and the Visual Analogue Score (VAS) recorded at 12 months post-randomisation. Secondary outcomes included quality of life using the EQ-5D instrument, symptomatic improvement and procedure-related complications. Results: Sixty participants were randomised to transvenous occlusion of incompetent pelvic veins or venography only. At 12 months, median pain scored 2 (3–10) in the intervention group versus 9 (5–22) in controls (p = 0.016). Pain on the VAS scored 15 (0–3) versus 53 (20–71), respectively (p = 0.002). Median EQ-5D improved after intervention from 0.79 (0.74–0.84) to 0.84 (0.79–1.00; p = 0.008) over 12 months. No major complications were reported. Conclusion: Transvenous occlusion of pelvic vein incompetence reduced pain scores, improved quality of life and diminished symptom burden with no major reported complications. Trial registration: ISRCTN 15091500.