Ovarian Vein Embolization

• What are some common uses of the procedure?
• How should I prepare for the procedure?
• What does the equipment look like?
• How does the procedure work?
• How is the procedure performed?
• What will I experience during and after the procedure?
• Who interprets the results and how do I get them?
• What are the benefits vs. risks?
• What are the limitations of the procedure?

 

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).

Common Uses

Ovarian vein 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?

Benefits

• 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 not required.
• 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 to recur.

Risks

• 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 reversed.
• 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 one percent.
• 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.