A recent study published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders (January 2026; DOI: 10.1016/j.jvsv.2025.102318) by Fabio Henrique Rossi and Antonio Massamitsu Kambara presents long-term outcomes following a personalised diagnostic and treatment strategy for pelvic venous disorder (PeVD) — a complex and heterogeneous condition often associated with chronic pelvic pain and venous insufficiency.
Pelvic venous disorder encompasses a broad spectrum of symptoms, including chronic pelvic pain, dyspareunia, hematuria, flank pain, and pelvic or lower-limb varicose veins. The variability in clinical presentation, anatomy and haemodynamics has historically complicated standardised management. In this study, the authors implemented an individualised treatment algorithm guided by detailed anatomical and haemodynamic assessment, using venography and intravascular ultrasound to direct therapy.
Between 2012 and 2022, 175 patients with PeVD were treated, with 146 patients (83.4%) achieving long-term follow-up beyond two years (mean follow-up approximately nine years). Based on diagnostic findings, patients underwent iliac vein stenting, ovarian or pelvic vein embolisation, spermatic vein embolisation, or renal vein stenting. Iliac vein stenting was the most frequently performed intervention, accounting for over half of treated cases.
Across all treatment groups, patients experienced significant and sustained reductions in pain, as measured by Visual Analogue Scale scores, alongside marked improvements in quality of life assessed using the Short Form-36 questionnaire. Notably, patients treated with iliac or renal vein stenting demonstrated substantial symptom relief without the need for adjunctive gonadal vein embolisation in many cases, highlighting the importance of addressing venous obstruction where present.
Complication rates were low, with only two cases of minor, asymptomatic gonadal vein bleeding reported, both managed conservatively. Reintervention rates varied by procedure but remained acceptable across all groups, supporting the durability of the personalised treatment strategy over extended follow-up.
This study reinforces the concept of a paradigm shift in the management of pelvic venous disorder, moving away from a one-size-fits-all approach toward tailored treatment based on individual venous anatomy and haemodynamics. Thorough preoperative assessment appears central to optimising outcomes and avoiding unnecessary interventions.
At Phlebology News, our aim is to provide clear and informative coverage of evolving evidence and clinical strategies in venous medicine, supporting clinicians in navigating complex conditions such as pelvic venous disorder with greater confidence and clarity.
