Trans-venous coiling for pelvic congestion syndrome: efficacy, safety, and clinical outcomes in an Egyptian cohort

Background and aim Pelvic congestion syndrome (PCS) is a significant cause of chronic pelvic pain in women of reproductive age, often associated with ovarian vein insufficiency. Traditional management with hormonal therapy or surgery may be invasive. We aimed to evaluate the efficacy and safety of trans-venous coiling (embolization) as a minimally invasive treatment for PCS in an Egyptian cohort. Patients and methods A prospective observational study was conducted at Al-Azhar University Hospital from 2023 to 2024. A total of 20 female patients (mean age: 30.55±6.67 years) with chronic pelvic pain unresponsive to conservative therapy and imaging-confirmed PCS were enrolled. Diagnosis was based on transvaginal ultrasound and computed tomography venography, demonstrating ovarian vein dilation and reflux. All patients underwent trans-venous coiling under fluoroscopic guidance. Technical success, symptom improvement [Visual Analog Scale (VAS)], and complications were assessed. Statistical analysis included descriptive statistics and Paired t -tests for pre and postprocedure VAS scores. Results Technical success, defined as complete occlusion of the target veins, was achieved in 100% of patients. The majority (90%) underwent left ovarian vein embolization, with a mean of 2.3 coils per patient. At 12-month follow-up, 90% of patients reported significant symptom improvement (VAS reduced from 7.4±1.2 to 1.8±0.9, P <0.001). Minor complications included mild contrast reactions (5%) and transient postprocedural pain (10%); no major adverse events or recurrences were observed. Conclusions Trans-venous coiling is a safe and effective treatment for PCS, providing substantial and durable symptom relief with minimal complications.