OBJECTIVE: To report feasibility, safety, and clinical outcomes of direct transvaginal ultrasound-guided foam sclerotherapy for isolated periuterine/pericervical varices or residual venous reservoirs after prior embolization. METHODS: Prospective single-center observational cohort including consecutive women (January 2023-October 2025) meeting predefined inclusion/exclusion criteria. Procedures were performed under general anesthesia using ultrasound-guided transvaginal venous puncture with fluoroscopic confirmation. Low-nitrogen 3% polidocanol foam was injected directly into the targeted periuterine and pericervical venous plexuses until complete filling of the treated reservoirs was achieved. PRIMARY ENDPOINTS: technical success and change in Pelvic Venous Clinical Severity Score (PVCSS) and Pelvic Varicose Vein Questionnaire (PVVQ) at 1 month and 1 year. Normality was evaluated with Shapiro-Wilk; repeated-measures ANOVA with Mauchly's test for sphericity; Tukey HSD for pairwise comparisons; α=0.05. Institutional Review Board approval was obtained; informed consent required. RESULTS: (SD 0.347) and a mean absorbed dose of 72 mGy (SD 3.1). All patients were discharged the same day and resumed normal activities the following day. Minor vaginal bleeding occurred in 82% the day after treatment; no menstrual disturbances were reported. Transvaginal ultrasound follow-up showed complete closure of the treated periuterine and pericervical venous plexuses, without evidence of recanalization in any patient at follow up. PVCSS improved from 12.91 at baseline to 7.87 (1 month) and 7.96 (1 year); PVVQ improved from 75.97 to 46.12 and 50.32, respectively. Overall improvement was significant (p<0.001). Tukey HSD confirmed reductions from baseline to 1 month and 1 year for both scales (PVCSS p<0.001; PVVQ p<0.003); 1-month vs 1-year differences were not significant (PVCSS p=0.987; PVVQ p=0.094). CONCLUSIONS: Direct transvaginal ultrasound-guided 3% polidocanol foam sclerotherapy achieved high technical success, significant and durable symptom improvement at 1 year in this small, highly selected cohort, with no major complications or recanalization. The technique offers a minimally invasive, targeted option for periuterine and pericervical venous reservoirs, particularly in cases not amenable to conventional endovascular access.
Hipola et al. (2026) studied this question.