trial of ovarian vein and pelvic vein embolization in women with chronic pelvic pain and pelvic varices

Conditions: Chronic Pelvic Pain Syndrome; Pelvic Pain; Pelvic Varices; Pelvic Congestive Syndrome; Pelvic Pain Syndrome

Summary: the purpose of this study is to see if a randomized controlled trial of ovarian vein and pelvic vein embolization versus venography alone could determine outcomes for women with chronic pelvic pain and pelvic varicose veins. the data gathered will assist in addressing changes in quality of life in patients who have ovarian/pelvic vein embolization versus no embolization.

the study is a randomized research trial of bilateral ovarian vein embolization (ove) and pelvic vein embolization (pve) in women with chronic pelvic pain (cpp), dilated and incompetent ovarian veins ≥6mm and pelvic varices (≥1 veins, \>5 mm diameter) to assess for change in pain. pain will be assessed by visual analog scale (vas) and other relevant, validated quality of life metrics including the patient-reported outcomes measurement information system (promis) item bank v.1.0 - pain intensity, patient-reported outcomes measurement information system (promis) scale v1.2 - global health, patient global impression of change (pgic) and euroqol five-dimension (eq 5d). the target population includes women age greater than or equal to 18 years who are pre-menopausal and have symptoms, and clinical and imaging findings corresponding to pelvic venous disease (pevd). subjects will be randomized in a 1:1 fashion to embolization (treatment group) or venography only (control group). follow-up will be assessed weekly and at 1, and 3 months and 6 months post procedure to assess for changes in quality of life in patients who receive ovarian/pelvic vein embolization versus no embolization.

Eligibility criteria:
inclusion criteria: presence of venous origin chronic pelvic pain for greater than 6 months as delineated by the following criteria: * pain exacerbated by walking, standing or lifting * symptoms are at least partially alleviated by lying down * prolonged post-coital ache * absence of non-venous origin cpp as determined by gynecology examination * symptoms-varices-pathophysiology classification: s2v2pbgv,r,nt, s2v2prgv,r,nt, s2v2plgv,r,nt * left or right ovarian vein diameter greater than or equal to 6 mm * presence of pelvic varices as documented by transabdominal ultrasound or ct (≥1 veins, \>5 mm diameter) exclusion criteria: * female \<18 years of age * pregnancy (positive pregnancy test) * female subject who plans to become pregnant during study period * female subject who is actively breastfeeding * patient who is post-menopausal or anovulatory * prior ovarian vein embolization or ovarian vein ligation * inability to tolerate endovascular procedure due to acute illness or general health * planned simultaneous treatment with nerve blocks during the duration of the study * laparoscopy or planned surgical intervention during the duration of the study * known allergy to sclerosant, coil, stent or catheter components including nickel allergy * significant iliac vein stenosis defined as \>61% area reduction as determined by the investigator at the time on pelvic dus or ct venogram prior to study procedure * significant renal vein stenosis with resultant hilar varices and lumbar collaterals as determined by the investigator at the time of venography * serious medical condition that might preclude full participation in the study to the desired endpoint (e.g., uncontrolled diabetes, malignancy, copd, mi, chf, etc.) * severe allergy to iodinated or gadolinium-based contrast refractory to steroid premedication * severe renal impairment (on chronic dialysis or estimated gfr \<30 ml/min) * hemoglobin \ 3.0 or platelet count \<75,000/microliter * inability to provide informed consent or to comply with study assessments * post thrombotic ivc, iliac or ovarian vein changes