Guideline Video

Guideline Resources

  • Venous Origin Chronic Pelvic Pain in Women
  • Society of Interventional Radiology
  • March 3, 2026
  • Summary
  • Full-text

Video Transcription

Just published March 3rd, 2026, the Society of Interventional Radiology’s newest guideline on Venous Origin Chronic Pelvic Pain in Women.

This guideline serves as a summary of what is required to treat women with venous origin chronic pelvic pain, including pre-procedural imaging, treatment options, complication management, and follow-up care. 

In today’s rapid update, we’ll be just going over a summary of the guidance statements from this guideline, so for the full guideline and recommendations, make sure to check it out on guidelinecentral.com.

Let’s get started. 

Starting with the guidance statements on Nomenclature and Definitions,

  • “Pelvic venous disorders,” or PeVD, is the term that encompasses conditions related to venous issues in the pelvis. Venous origin chronic pelvic pain, or VO-CPP, is the preferred term, over pelvic congestion syndrome, to define a PeVD associated with chronic pelvic pain.
  • VO-CPP stems from pelvic venous hypertension due to venous reflux or outflow obstruction; in many cases, this is evidenced by dilated periuterine and periovarian varices.

Next the section on Classification,

  • The Symptoms-Varices-Pathophysiology, or SVP, classification should be used in clinical assessments and research reporting for precise characterization of the patient's clinical condition.

On to the section on Clinical Evaluation,

  • Patients with PeVD may have multiple venous abnormalities contributing to their symptoms. Effective treatment plans are dependent on the identification of all of the underlying venous conditions contributing to the patient’s presentation. 
  • Patients with suspected VO-CPP should be counseled on the various treatment options, including conservative, endovascular, and surgical management.

For the guidance statements on Imaging,

  • The suspicion of VO-CPP should be confirmed by clinical evaluation, including a comprehensive assessment of the patient’s history, physical exam and imaging. 
  • There are currently no published consensus diagnostic imaging criteria for PeVD though imaging findings are crucial to the diagnosis. 

Then for the guidance statements on Comorbidities, 

  • Chronic pelvic pain (CPP) often includes symptoms suggesting multiple pain generators and can be associated with depression, anxiety, and catastrophizing. Vascular interventionalists should collaborate with providers from other disciplines to address these issues, which may lead to persistent CPP after technically successful venous interventions. 
  • Patients with CPP should be evaluated and counseled on the possibility of venous as well as other etiologies for chronic pain.

Now on to the section on Management of VO-CPP,

  • Embolization for VO-CPP may include one or both ovarian veins and/or internal iliac veins as well as liquid/foam embolization/sclerotherapy of the pelvic venous reservoir. 
  • In S2,3 V2,3 patients, interventional treatment may begin the following procedures based on pathophysiology: ovarian vein embolization, internal iliac vein embolization, and iliac venous stent insertion, often in a staged manner.
  • Left common iliac vein compression or obstruction can result in secondary pelvic venous reflux and result in VO-CPP. 
  • Left renal vein compression can lead to secondary left ovarian vein reflux and VOCPP. An intra-procedural assessment of the hemodynamic significance of the left renal vein compression prior to ovarian vein embolization is recommended.
  • In S2 patients with left renal vein compression and ovarian vein reflux, embolization of the ovarian vein is appropriate when preembolization ovarian vein occlusion does not elevate the renal vein to IVC gradient to > 3mmHg. 

Now the guidance statement on the Endovascular Management of Vulvar Varicose Veins

  • Treatment of symptomatic vulvar varicose veins should be determined by the patient’s dominant clinical symptoms. For isolated vulvar varicose veins without abdominal or pelvic pain, it is most appropriate to treat just the vulvar varicosity percutaneously without pelvic venous embolization. For patients with concurrent clinically significant pelvic pain and vulvar varices, embolization of the pelvic venous reservoir can be considered primarily followed by percutaneous sclerosis of the vulvar varices if still needed.

Next, the section on Surgical Interventions

  • A multidisciplinary evaluation is recommended for S₂ V₂ PLRV,O,NT; LGV,R,NT patients, including surgical consultations to assess potential treatment for left renal vein compression. Embolization of the ovarian vein should be avoided until surgical options have been discussed.

For the section on Reproductive Outcomes,

  • While there are limited data available, ovarian vein embolization for PeVD is considered safe in women desiring future pregnancy.

On to the section on Complications,

  • The most common complication of ovarian and pelvic venous embolization is postembolization syndrome, consisting of low-grade fever and pain in the pelvis, abdomen, or back. Other severe complications, including coil migration and pulmonary embolism, are rare.

And last, the guidance statement on Conclusions, 

  • Multiple surgical interventions exist for the treatment of VO-CPP which can be tailored depending on the SVP, endovascular options, and cause of patient symptoms. A multidisciplinary approach and discussion is recommended prior to any interventions.

And there you have it. Make sure to check out the full guideline from the Society of Interventional Radiology and other related clinical decision support tools at guidelinecentral.com.

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