Delphi consensus on diagnostic and therapeutic pathways for pelvic venous disorders – A multidisciplinary algorithm

Summary: Background: Pelvic venous disorders (PeVD) are associated with chronic pelvic pain and varicose veins due to venous insufficiency and pooling in the pelvis. Despite increasing interest, there is a lack of widely accepted diagnostic algorithms and validated criteria, which complicates diagnosis and management. This study aimed to develop and validate a diagnostic and therapeutic algorithm for PeVD using expert consensus. Materials and methods: An independent Advisory Board (AB) of 11 Italian specialists (gynaecologist, radiologists, vascular surgeons, and angiologists) was convened. A literature review informed the development of a draft algorithm. Three Delphi survey rounds were conducted, with online and in-person discussions, and a consensus threshold set at ≥70%. Results: All 11 AB members completed the first two survey rounds, and eight completed the third. The median number of diagnosed and treated PeVD cases per expert was 20 and 12 per year, respectively. The group agreed on classifying PeVD into Pelvic Congestion Syndrome (PCS) and compressive/obstructive syndromes. Endovascular therapy was recognised as standard of care: pelvic embolisation for PCS, stenting for obstructive lesions, and combined approaches when both are present. Clinical success was defined as subjective symptom improvement assessed 3–6 months post-procedure. Treatment failure warranted re-evaluation and possible reintervention. Surgical treatment was considered only when conservative and endovascular options failed (37.5% agree, 50% neutral). Conclusions: This Delphi-based consensus produced a validated, multidisciplinary algorithm for the diagnosis and treatment of PeVD. It highlights the need for standardised clinical pathways, but further validation by a broader expert community is warranted.