Analysis of factors influencing the efficacy of ovarian vein embolization for pelvic venous insufficiency and development of a short-term efficacy prediction model with internal validation.

OBJECTIVE: The study aims to elucidate the factors associated with the short-term efficacy of ovarian vein embolization (OVE) in the treatment of pelvic venous insufficiency (PVI), to construct a predictive model for short-term efficacy of OVE.

METHODS: Clinical and ultrasound data were retrospectively collected from female patients with PVI and underwent OVE at Beijing Shijitan Hospital between January 2019 and February 2025. This study used the minimal clinically important difference to define symptomatic improvement in the Pelvic Venous Clinical Severity Score. Symptomatic improvement was used as the evaluation criterion, and the related factors affecting the short-term efficacy were analyzed. The receiver operating characteristic curve was also applied to assess the predictive efficacy of the model and calculate the optimal efficiency cut-off value. Internal validation was performed using k-fold cross-validation to assess discrimination, calibration, and clinical utility.

RESULTS: The study included a total of 82 patients: 43 patients in the remission group and 39 patients in the nonremission group. No statistically significant differences were found between the two groups with regard to age, body mass index, history of abortion, history of varicose veins of the lower extremities, the number of pregnancies and deliveries. The duration of lower abdominal discomfort in the nonremission group was longer than that in the remission group (t = -1.713; P = .004; independent samples t test). Transabdominal ultrasound showed that the diameter of the left ovarian vein (OV) in the nonremission group was smaller (Z = -2.958; P = .003; Mann-Whitney U test), and the diameter of the left parametrial vein in the nonremission group was smaller (Z = -2.494; P = .013). In addition, the positive rate of internal iliac vein reflux in the nonremission group was higher (χ2 = 15.649; P < .001; χ2 test or Fisher's exact test). Binary logistic regression analysis showed that the longer the duration of lower abdominal discomfort (odds ratio [OR], 1.115; 95% confidence interval [CI], 1.001-1.332; P = .049), the smaller the diameter of the left OV (OR, 0.669; 95% CI,0.483-0.928; P = .016) and internal iliac vein reflux (OR, 6.449; 95% CI, 2.238-15.583; P < .001) were independent risk factors for the short-term efficacy of OVE for PVI. The area under the receiver operating characteristic curve (AUC) was 0.807 (95% CI, 0.712-0.902), and the best cut-off value was 0.453. The sensitivity and specificity of predicting the short-term efficacy of OVE were 82.1% and 74.4%, respectively. Internal validation showed acceptable discrimination (area under the receiver operating characteristic curve = 0.779), a Brier score of 0.176 indicating adequate accuracy, reasonable calibration, and positive net clinical benefit in decision curve analysis.

CONCLUSIONS: The duration of lower abdominal discomfort, OV diameter, and internal iliac vein reflux are independent predictors of the short-term efficacy of OVE for PVI. The prediction model of short-term efficacy of OVE for PVI in this study has satisfactory validity.

CLINICAL RELEVANCE: This study developed an exploratory predictive model to evaluate the risk of nonremission at 3 months after OVE in patients with symptomatic PVI. Three key predictors were identified: duration of pelvic discomfort, left OV diameter, and the presence of internal iliac vein reflux. The model enables preoperative identification of patients at high risk for adverse short-term outcomes.