Ovarian Vein Embolization
Ovarian vein embolization is a minimally invasive treatment used
to block blood flow to the veins causing pelvic congestion. In this
technique, an interventional radiologist threads a thin tube (catheter),
through a small nick in the skin near the groin. Guided by X-ray
imaging, the physician moves the catheter to the ovarian veins. If
the imaging reveals a cluster of serpentine veins, the physician
passes tiny coils through the catheter into the ovarian vein. The
coils help form a clot that subsequently blocks the accumulation
of blood in the enlarged veins (varices).
embolization can be effective for patients meeting the selection
criteria. Studies have shown that 80% of women have pain improvement
or relief within 2-3 weeks of their procedure. The embolization procedure
may require multiple sessions. They may be performed on an inpatient
or outpatient basis depending on the veins that are accessed and
the technique that is used.
How Should I Prepare For The Procedure?
Blood tests are routinely ordered; you may have blood drawn at
the hospital or a nearby clinic. You may be instructed to temporarily
stop taking certain medications such as those that thin the blood.
If you have diabetes it may be necessary to alter your insulin
dose on the day of angioplasty. The radiologist or a staff person
will ask you to sign a consent form that covers angioplasty. It
also will cover angiography, an x-ray study of the arteries involving
injection of contrast material.
Make sure that the radiologist knows if you have any allergies so
that special precautions can be taken. You will be asked not to eat
solid foods after midnight, but may take clear liquids. Smoking is
to be avoided the day before the procedure. Shortly before starting,
the area where the catheter is to be inserted in the groin or arm
will be shaved and washed with antibacterial soap to prevent infection.
In addition, you will have a tube placed into a vein in the arm or
hand to receive fluids and medicines as needed. The intravenous (IV)
line is used to give a sedative to help you relax and possibly make
you drowsy. It will stay in place until angioplasty is completed.
What Does The Equipment Look Like?
Several different types of particles
are available for ovarian vein embolization. These include tiny coils
of stainless steel, gelatin sponge, and embolization medications.
All of these types of embolization agents have been shown to be safe
and effective. Regardless of the type of particles used, they wedge
in the ovarian vessels, avoiding the risk that they will travel to
distant parts of the body.
How Does The Procedure Work?
By blocking blood flow to the ovarian varices, ovarian vein embolization
shrinks the enlarged veins and eliminates their ability to cause
pain. The symptoms they previously caused become less bothersome
or may disappear altogether.
How Is The Procedure Performed?
The embolization procedure
Ovarian vein embolization is carried out in an angiography suite
equipped with an x-ray machine, where sterile conditions are maintained.
Your heart rate, blood pressure, electrocardiogram, breathing and
blood oxygen level will be monitored constantly during the procedure,
which typically takes between 60 and 90 minutes.
After injecting a sedative to make you sleepy and a local anesthetic
to numb the skin at the groin, the interventional radiologist will
make a small nick in the skin less than a quarter inch long and thread
a thin tube (catheter) into the femoral artery. Using x-ray guidance,
and periodic injections of radiographic contrast material to map
the blood vessels, the catheter is threaded into the ovarian veins.
Under x-ray observation, tiny coils are injected until blood flow
in the enlarged ovarian veins is blocked. After completing ovarian
vein embolization, the site of skin puncture is cleaned and bandaged.
What Will I Experience During The Procedure?
Most patients having
ovarian vein embolization remain overnight in the hospital for pain
control and observation. Patients typically experience pelvic cramps
for several days after ovarian vein embolization, and possibly mild
nausea and low-grade fever as well. The cramps are most severe during
the first 24 hours after the procedure, and improve rapidly over
the next several days. While in the hospital, the discomfort usually
is well controlled with a narcotic pump, which dispenses intravenous
pain medication. Oral pain medication will be provided when you are
discharged home the following day. Most patients will recover from
the effects of the procedure within one to two weeks after ovarian
vein embolization, and will be able to return to their normal activities.
Most women experience a reduction in pelvic pain in two to three
weeks, and are able to return to work one week after ovarian vein
embolization, but occasionally patients take longer to recover fully.
Who Interprets The Results And How Do I Get Them?
The interventional radiologist who performs your procedure will
interpret the results and will work with your gynecologist or primary
care physician to ensure proper follow-up care.
What Are The Benefits Vs. Risks?
- Minimally invasive: Ovarian vein embolization
is less invasive than the open surgery alternative of removing the
uterus itself (hysterectomy). Patients ordinarily can resume their
usual activities weeks earlier than if they had a hysterectomy. Blood
loss during ovarian vein embolization is minimal, the recovery time
is much shorter than for hysterectomy, and general anesthesia is
- Relief of symptoms: Follow-up studies have shown
that approximately 65 to70 percent of women who have their Pelvic
Venous Congestion Syndrome treated by ovarian vein embolization
experience either significant reduction or complete resolution
of their pain-related symptoms.
- Durable effect: Follow-up studies lasting several
years have shown that it is rare for pelvic vein congestion syndrome
- Catheter-related risks: Any procedure that
involves placement of a catheter inside a blood vessel, including
ovarian vein embolization, carries certain risks. These risks include
damage to the blood vessel, bruising or bleeding at the puncture
site, and infection. When performed by an experienced interventional
radiologist, the chance of any of these events occurring during ovarian
vein embolization is less than one percent.
- Allergy to x-ray contrast material: An occasional
patient may have an allergic reaction to the x-ray contrast material
used during ovarian vein embolization. These episodes range from
mild itching to severe reactions that can affect a woman's breathing
or blood pressure. Women undergoing ovarian vein embolization are
carefully monitored by a physician and a nurse during the procedure,
so that any allergic reactions can be detected immediately and
- Early onset menopause: In the majority of women
undergoing uterine OVE, normal menstrual cycles resume after the
procedure. However, in approximately one percent of women, menopause
occurs shortly after embolization. This appears to occur more commonly
in women who are older than 45 years when they have the procedure.
- Need for hysterectomy: Although the goal of
embolization is to cure symptoms without surgery, some women may
eventually need to have a hysterectomy because of infection or
persistent symptoms. The likelihood of requiring hysterectomy after
embolization is low—less than
- X-ray exposure: Women are exposed to x-rays
during ovarian vein embolization, but exposure levels usually are
well below those where adverse effects on the patient or future
children would be a concern.
What are the limitations of Ovarian Vein Embolization?
Unfortunately, pelvic pain is a very common symptom in women, and
there is no definitive test for pelvic venous congestion syndrome.
Therefore, it can be difficult to select the patients that might
benefit from ovarian vein embolization. Pelvic pain in some women
may be due to many causes that are additive, and treating the PVC
may only address part of the problem. Pelvic pain often requires
multiple physicians working as a team with the patient to produce
a desirable result of resolution of symptoms.