Comparison of Embolization Using Coil Versus Coil and Ethylene Vinyl Alcohol Copolymer in Pelvic venous Disorders

Background

Endovascular treatments are frequently applied in pelvic venous disorders (PeVDs) with guidelines recommendations. There is no clear answer as to which of the embolization methods applied with endovascular treatments is superior. In this study, we aimed to compare the outcomes and symptom relief of patients with PeVDs treated using coils alone versus those treated with both coils and ethylene vinyl alcohol copolymer, as well as to evaluate the material usage and safety and efficacy of these treatments.

Methods

Patients with PeVDs who underwent embolization of ovarian veins with coil and/or ethylene vinyl alcohol copolymer between January 2022 and April 2024 were included in the study. These patients were divided into 2 groups: patients who underwent coil embolization only (Group I) and patients who used ethylene vinyl alcohol copolymer together with coils (Group II). These patients were followed up at first, third 6th and 12th months postoperatively. Symptoms were evaluated with an examination and a visual analog scale (VAS).

Results

Between January 2022 and April 2024, 90 patients with PeVDs who underwent endovascular treatment of their ovarian and pelvic veins were included in our study. 31 patients underwent coil embolization only (Group I), while 59 received both coil embolization and a ethylene vinyl alcohol copolymer (Group II). The mean age was 37.5 ± 7.9 and 40.4 ± 7.9 for Groups I and II, respectively. In group I, When pelvic pain was evaluated with VAS, there was a significant decrease in VAS scores between the preoperative period and at the first (VAS: 5.3 ± 0.9), third (VAS:3.9 ± 1.2), sixth (VAS: 3.5 ± 1.5), and 12^th (VAS: 3.6 ± 1.5) months postoperatively (P = 0.011, <0.001, <0.001, <0.001, respectively). In Group II, When pelvic pain was evaluated with VAS, there was a similarly significant decrease in VAS scores between the preoperative period and the first (VAS: 5.3 ± 1.4), third (VAS: 3.3 ± 1.7), sixth (VAS: 2.8 ± 1.8), and 12^th (VAS: 2.5 ± 2.1) months postoperatively (P = 0.002, <0.001, <0.001, <0.001, respectively). Group II demonstrated significantly lower VAS scores at the third, sixth, and 12th months compared to Group I. When examining the clinical symptoms of the patients individually, no significant differences were observed between the preoperative and first-month VAS scores for any specific symptom. However, at the third, sixth, and 12th months, while there were no significant differences between Group I and Group II in terms of menstrual pain, Group II exhibited significantly lower scores for standing abdominal pain, sitting abdominal pain, and dyspareunia.

Conlusions

In our study, the use of ethylene vinyl alcohol copolymer and coils in the embolization of PeVDs is considered an effective and safe procedure with a higher clinical efficacy rate compared to other embolization techniques. Additionally, the use of ethylene vinyl alcohol copolymer reduces the need for coils, providing a cost-effective advantage.