Transcatheter cyanoacrylate embolization vs. pharmacologic therapy for gonadal vein reflux in symptomatic pelvic venous disorders: a randomized controlled trial

PURPOSE: Pelvic venous disorders (PeVDs) with gonadal vein reflux are a frequently overlooked cause of chronic pelvic pain in women. Although embolization is increasingly used in practice, high-quality comparative evidence-particularly for cyanoacrylate glue-remains limited. This randomized controlled trial compares cyanoacrylate embolization with conservative pharmacologic management in women with symptomatic PeVDs. METHODS: , 500 mg twice daily) or transcatheter cyanoacrylate embolization. The primary endpoint was the change in pelvic pain measured by the visual analog scale (VAS). Secondary outcomes included dyspareunia and dysmenorrhea VAS scores, clinical success, symptom recurrence, and adverse events over 12 months. RESULTS: = 0.021). No major complications were reported. CONCLUSION: In women with symptomatic gonadal vein reflux, cyanoacrylate embolization, compared with conservative pharmacologic therapy, appears to provide significantly greater and more durable symptom relief, with low recurrence and an excellent safety profile, although the difference in clinical success rates did not reach statistical significance. CLINICAL SIGNIFICANCE: In this randomized trial, cyanoacrylate embolization was particularly beneficial for women with documented gonadal vein reflux and symptoms dominated by non-cyclic pelvic pain and dyspareunia. In appropriately selected patients, early intervention may reduce recurrence and avoid prolonged medical therapy with limited durability. Although these preliminary findings support embolization as a potential definitive therapeutic option, larger confirmatory studies are needed before it can be recommended over second-line status.