Ovarian vein embolisation for pelvic congestion syndrome

Ovarian vein embolization (OVE) is a minimally invasive procedure used to treat pelvic congestion syndrome (PCS), a condition characterized by chronic pelvic pain due to varicose veins around the ovaries and pelvic area. The procedure involves blocking or occluding the abnormal veins responsible for causing the pain, thereby alleviating symptoms and improving the patient’s quality of life.

Indications

OVE is indicated for patients with:

1. Pelvic Congestion Syndrome (PCS): Chronic pelvic pain associated with varicose veins in the pelvic region, typically affecting women of reproductive age (Click here to read more on Pelvic Congestion Syndrome)
2. Symptomatic Varicose Veins: Pain, discomfort, or other symptoms caused by enlarged and tortuous ovarian veins (Click here to read more on Varicose Veins)
3. Failure of Conservative Management: Patients who have not responded adequately to conservative treatments such as pain medications, lifestyle modifications, or compression therapy.

Procedure

1. Pre-procedure Evaluation:
   • Imaging Studies: Pelvic ultrasound, MRI, or CT scans are used to identify dilated and tortuous veins and confirm the diagnosis of PCS.
   • Patient Assessment: Evaluation of medical history, symptoms, and suitability for the procedure.
2. Preparation:
   • Informed Consent: Explanation of the procedure, its risks, benefits, and alternatives, followed by obtaining informed consent from the patient.
   • Antibiotics: Prophylactic antibiotics may be administered to prevent infection.
3. Anaesthesia:
   • OVE is typically performed under local anaesthesia with conscious sedation to ensure patient comfort.
4. Procedure:
   • Catheter Insertion: A small incision is made, usually in the groin or neck, to access a major vein (femoral vein or internal jugular vein).
   • Guidewire Placement: A guidewire is advanced through the catheter and navigated into the target ovarian vein under fluoroscopic guidance.
   • Embolization: Embolic agents (e.g., coils, sclerosing agents, or foam) are introduced through the catheter and guided to the target veins, blocking blood flow and causing the veins to collapse.
   • Confirmation: Contrast dye may be injected to confirm successful occlusion of the abnormal veins and to assess blood flow.
5. Post-procedure Care:
   • The catheter and guidewire are removed, and pressure is applied to the insertion site to prevent bleeding.
   • Patients are monitored for a brief period post-procedure to watch for any immediate complications.
   • Post-procedure instructions, including activity restrictions and follow-up appointments, are provided.

Benefits

• Pain Relief: Significant reduction or resolution of pelvic pain and associated symptoms.
• Minimally Invasive: Less invasive than surgical options, with smaller incisions and faster recovery.
• Improved Quality of Life: Relief from chronic pain can lead to improved physical and emotional well-being.

Risks and Considerations

• Infection: Risk of infection at the catheter insertion site.
• Bleeding: Minor bleeding or bruising at the insertion site.
• Allergic Reactions: Rarely, patients may have allergic reactions to contrast dye or embolic agents.
• Recurrence: In some cases, varicose veins may recur over time, necessitating additional treatments.
• Complications: Although uncommon, potential complications include vessel perforation, migration of embolic material, or damage to surrounding structures.

Conclusion

Ovarian vein embolization is an effective and minimally invasive treatment option for pelvic congestion syndrome, providing significant pain relief and improving the quality of life for affected patients. By blocking the abnormal veins responsible for pelvic pain, OVE offers a safe and efficient solution, particularly for those who have not responded well to conservative management. Close monitoring and follow-up care are essential to ensure optimal outcomes and address any potential complications.