Understanding Recurrence in Pelvic Venous Disorders through the Symptoms-Varices-Pathophysiology Classification: A Multicenter Prospective Cohort Study.

PURPOSE: To identify components of the Symptoms-Varices-Pathophysiology (SVP) classification predictive of clinical recurrence after embolization of the 4 major pelvic venous axes in patients with pelvic venous disorders (PeVDs).

MATERIALS AND

METHODS

This prospective multicenter cohort study included women with PeVD treated at 6 hospitals using a unified diagnostic, embolization, and follow-up protocol. Clinical, anatomical, and hemodynamic variables were classified according to the SVP system. Recurrence was defined as clinical worsening with a ≥1-category increase in visual analog scale score, associated with duplex ultrasound (US) evidence of directed reflux and venographic confirmation of an active escape pathway. Statistical analysis included chi-square testing, logistic regression, relative risk (RR) estimation, and Kaplan-Meier analysis.

RESULTS

Among 244 patients, 117 (48.0%) developed clinical recurrence during 24 months of follow-up. Nonsaphenous lower-extremity varices (V3b) were present in 75.8% of the cohort and were strongly associated with recurrence. Patients with V3b varices had higher re-embolization rates (52.4% vs 34.5%; RR, 1.52; P = .016). In multivariate analysis, V3b was the only independent predictor of recurrence (odds ratio, 16.16; 95% CI, 5.23-49.92; P < .001). Recurrence occurred earlier and more frequently in patients with V3b varices, with reduced recurrence-free survival on Kaplan-Meier analysis (hazard ratio, 2.56; P < .001).

CONCLUSIONS

V3b varices are the strongest independent predictor of clinical recurrence after embolization for PeVD, representing a compensated hemodynamic phenotype with persistent extrapelvic decompression. Identification and targeted treatment of these escape pathways should be incorporated into diagnostic and therapeutic strategies.