ArticleJournal of vascular surgery. Venous and lymphatic disorders2026
Bottom-up versus top-down treatment strategies for pelvic venous disorders: Comparative analysis of pain relief, recurrence, and procedural burden.
Article in Journal of vascular surgery. Venous and lymphatic disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo compare a peripheral "bottom-up" strategy using ultrasound-guided foam sclerotherapy with a conventional "top-down" embolization strategy in women with symptomatic pelvic venous disorders, with respect to pain relief, recurrence-free survival, and procedural burden.
methodsThis was a retrospective analysis of prospectively collected data from 40 women treated between January 2024 and December 2024, all classified as S3V3Pr according to the symptoms-varices-pathophysiology classification. Pain was categorized by anatomical location as pelvic pain above the pelvic floor, vulvar pain, perineal pain, or lower-limb pain related to varicose veins. Twenty patients underwent top-down treatment, and 20 underwent bottom-up treatment. The primary endpoint was change in the visual analog scale pain score. Secondary endpoints included recurrence-free survival, technical success, radiation exposure measured by dose-area product, procedure time, and direct procedural cost.
resultsBaseline pain severity was identical in the two groups (7.36 ± 1.34 vs 7.36 ± 1.07; P = 1.00). Both treatment strategies were associated with significant improvement in pain at follow-up (top-down, 7.36 ± 1.34 to 1.90 ± 1.07; bottom-up, 7.36 ± 1.07 to 2.49 ± 1.26; both P < .001), with no significant between-group difference in post-treatment pain (P = .12). Compared with top-down treatment, bottom-up treatment was associated with substantially lower dose-area product, shorter procedure time, and lower direct procedural cost (all P < .001). Technical success was achieved in all patients. Kaplan-Meier analysis showed lower recurrence-free survival in the top-down group, with an estimated 12-month recurrence-free survival of 70% vs 95% in the bottom-up group (log-rank P = .035).
conclusionsIn women with S3V3Pr pelvic venous disorders, bottom-up foam sclerotherapy provided comparable pain relief to top-down embolization while reducing radiation exposure, procedure time, and direct procedural cost.
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