Embolization Strategies for Pelvic Venous Disorders: Foam + Glue vs Foam + Coils

Inclusion criteria

• Female patients aged 18 to 50 years
• Clinically suspected pelvic venous disorder (PVD), presenting with chronic pelvic pain ≥ 6 months
• Pelvic pain intensity ≥ 4 on a 10-point Visual Analogue Scale (VAS) at baseline
• No evidence of significant venous obstruction or internal iliac insufficiency
• Willingness to participate, provide written informed consent, and comply with study visits and procedures exclusion criteria
• Pregnancy or planning to conceive within the next 12 months
• Significant Nutcracker syndrome diagnosed by duplex / CTV / MRV
• Significant May-Thurner syndrome diagnosed by duplex / CTV / MRV
• Non-ovarian sources of reflux requiring intervention, including internal iliac vein insufficiency; During venography all patients will undergo selective pelvic venography prior embolization to exclude patients who have combined gonadal and internal iliac vein reflux)
• History of previous pelvic vein embolization or surgical ligation
• Coagulopathy, defined as:

• INR > 1.5
• Platelet count < 50 × 10⁹/L
• Severe comorbidities, including:

• Active pelvic infection (e.g., pelvic inflammatory disease)
• End-stage renal disease (eGFR < 30 mL/min/1.73 m²)
• Decompensated heart failure (NYHA class III-IV)
• Active malignancy requiring treatment

Known allergy or hypersensitivity to:

• Iodinated contrast media
• Polidocanol (Aethoxysklerol®)
• N-butyl cyanoacrylate (e.g., Gluebran® 2)
• Nickel, platinum, or stainless steel (components of embolization coils) . Presence of non-venous pelvic pathology requiring immediate management