Ovarian vein embolization is a minimally invasive treatment for pelvic congestion syndrome, a painful condition resulting from the presence of enlarged or varicose veins in the pelvis. It helps relieve pain by using imaging guidance and a catheter to close off faulty veins so they can no longer enlarge with blood. Embolization is a highly effectively way of controlling bleeding and much less invasive than open surgery.
Tell your doctor if there's a possibility you are pregnant and discuss any recent illnesses, medical conditions, allergies and medications you're taking, including herbal supplements and aspirin. You may be advised to stop taking aspirin, vitamin E, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure. You should have nothing to eat or drink after midnight the night before. Plan to be admitted to the hospital on the morning of your procedure, leave jewelry at home, and wear loose, comfortable clothing. You may be asked to wear a gown.
What are the limitations of Ovarian Vein Embolization?
Ovarian vein embolization is a minimally invasive treatment for pelvic congestion syndrome that is used to close off faulty veins so they can no longer enlarge with blood, thus relieving the pain.
Pelvic congestion syndrome, also known as ovarian vein reflux, is a painful condition resulting from the presence of varicose veins in the pelvis. The condition is caused by valves in the veins that help return blood to the heart against gravity becoming weakened and not closing properly, allowing blood to flow backwards and pool in the vein causing pressure and bulging veins. Diagnosis of the condition is done through one of several methods: pelvic venography, magnetic resonance imaging and pelvic and transvaginal ultrasound.
During this procedure, an interventional radiologist inserts a catheter up the femoral vein and into the faulty vein(s). Catheterization requires only a small nick in the skin for insertion and x-ray image guidance of the catheter to its target area. The catheter delivers Dacron filaments-bearing coils that clot the blood and seal the faulty vein. The use of the recently developed Sotradecol foam agent allows the radiologist to block even the smallest veins not previously accessible.
Stop taking aspirin and vitamin E at least five days before the procedure.
Do not eat or drink anything after midnight prior to the procedure.
In general, you should not eat or drink anything after midnight the day of your procedure. However, you may take your routine medications with sips of water. If you are diabetic and take insulin, you should talk to your doctor as your usual insulin dose may need to be adjusted.
X-ray equipment, a catheter and a variety of synthetic materials and medications, called embolic agents, are used in this procedure.
Gelfoam™, a gelatin sponge material, which is cut into small pieces that are injected into an artery and float downstream until they can go no further. After a period ranging from a few days to two weeks, the material dissolves. Gelfoam is used to control bleeding until the cause can be identified and fixed, or until it has time to heal on its own.
particulate agents, including Polyvinyl alcohol (PVA) and gelatin-impregnated acrylic polymer spheres, which are suspended in liquid and injected into the bloodstream to block small vessels. These agents are used to block, or occlude, vessels permanently.
various sized metal coils made of stainless steel or platinum are used to block large arteries.
liquid sclerosing agents, which are used to destroy blood vessels and vessel malformations. Filling a vessel or a vessel malformation such as a fistula with this liquid agent causes blood clots to form, closing up the abnormal vascular channels.
liquid glue, which can be inserted into a fistula or arteriovenous malformation (AVM) where it hardens, filling in this unnecessary passageway between artery and vein.
Using x-ray imaging and a contrast material to visualize the blood vessel, the interventional radiologist inserts a catheter through the skin into a blood vessel and advances it to the treatment site. A synthetic material or medication called an embolic agent is then inserted through the catheter and positioned within the blood vessel or malformation where it will remain either permanently or temporarily.
Temporary embolic agents block blood vessels long enough to allow the body to heal on its own. Permanent embolic agents physically plug-up blood vessels and cause scar tissue to form in the vessel. This is important in treating conditions such as arteriovenous malformations and tumors, which would recur if the embolic agent dissolved.
Image-guided, minimally invasive procedures such as embolization for pelvic congestion syndrome should be performed by a specially trained interventional radiologist in an interventional radiology suite or occasionally in the operating room.
Using image-guidance, a catheter (a long, thin, hollow plastic tube) is inserted through the skin to the treatment site.
A contrast material then is injected through your IV and a series of x-rays are taken to locate the exact site of bleeding or abnormality. The medication or embolic agent is then injected through the catheter. Additional angiograms are taken to ensure the embolic agent is correctly positioned and that any bleeding is controlled.
Most patients experience some side effects after embolization. Pain is the most common and can be controlled by medication given by mouth or through your IV.
Most patients leave the hospital within 24 hours of the procedure, but those who have considerable pain may have to stay longer.
In cases of bleeding, it may take 24 hours to know whether it has stopped. It may be one to three months after embolization before it is clear whether symptoms have been controlled or eliminated.
Worldwide success rates of 85 percent and higher have been reported in women treated with embolization.
Successful embolization without injuring normal tissue requires that the catheter be placed in a precise position. This means that the catheter tip is situated so that embolic material can be deposited only in vessels serving the abnormal area. In a small percentage of cases, the procedure is not technically possible because the catheter cannot be positioned appropriately.