Comparative Study between Isolated Iliac Vein Stenting vs. Concomitant Iliac Vein Stenting with Pelvic Vein Embolization in Patients with Pelvic Venous Insufficiency Secondary to Nonthrombotic Iliac Vein Lesions.

BACKGROUND: Pelvic venous insufficiency (PVI) may reflect combined iliac outflow obstruction and pelvic venous reflux. This study aimed to compared iliac vein stenting alone versus stenting plus pelvic vein embolization (PVE) in women with PVI secondary to nonthrombotic iliac vein lesions. METHODS: In this prospective randomized two-arm trial, 20 women (18-50 years) with Greiner type 2 pelvic congestion and duplex-confirmed nonthrombotic iliac vein lesions (PSV ratio >2.5) were randomized 1:1 to stent-only (n=10) or stent + embolization (n=10). Embolization targeted pelvic escape pathways using coils and 3% polidocanol. The primary outcome was change in Pelvic Venous Clinical Severity Score (PVCSS). SVP classification and follow-up hemodynamics were recorded. RESULTS: Procedure duration was longer with stent + embolization (2.0 ± 0.41 vs 1.3 ± 0.42 hours; P=0.001). Technical and procedural success were 100% in both groups, with no major adverse events. Sustained clinical improvement was higher with combined therapy (100% vs 50%; P=0.01). SVP normalization to symptom class S0 and varices class V0 occurred more often with combined therapy (both 100% vs 40%; P=0.003). Postoperative PVCSS was lower with combined therapy (4.1 ± 0.74 vs 6.6 ± 2.88; P=0.016), with greater absolute improvement (10.90 ± 1.60 vs 7.10 ± 2.64; P=0.001). Persistent reflux was more frequent after stenting alone (70% vs 0%; P=0.001). CONCLUSIONS: In women with PVI due to nonthrombotic iliac lesions, adding PVE to iliac stenting improved short-term symptom and hemodynamic outcomes, at the cost of longer procedure time.