What is Pelvic Congestion Syndrome?
Pelvic congestion syndrome (PCS) is a common cause of chronic pelvic pain in women. Other terms used for this include pelvic venous congestion and pelvic venous disease.
Blood carried from the ovarian veins usually have valves to allow forward flow of blood towards the heart. These valves may be absent in some women, or may fail, resulting in pooling of blood in pelvic veins, which in turn results in stretching of these veins and raised venous pressure, very much like leg varicose veins you may have seen before.
Pelvic Congestion Syndrome Pain
Women with PCS often describe pain that is dull, constant, progressively worse throughout the day, worse with prolonged sitting, standing or heavy activity, and relieved with laying down. The pain if often worse during menstruation and can also cause pain during or after intercourse. However, not all women describe all of these features, and their pain may be of a different quality. There are also other related symptoms that may not be recognised as such by your doctor, such as bladder irritability, lower back, and thigh pain, as well as varicose veins in the leg or vulva.
What is Ovarian Vein Embolisation (OVE) Treatment?
The first line treatment for pelvic congestion syndrome is ovarian vein embolisation. Medical treatment is focused on pain relief and it only temporary. Hormone treatment to suppress ovarian function offers only a few months of relief. Open or laparoscopic surgery (including hysterectomy) is not recommended, as it is less effective and more invasive than embolisation.
Embolisation is a procedure that involves blocking up the dysfunctional veins, thereby eliminating these problematic veins from the circulation, causing the blood to be redirected into properly functioning veins.
Occasionally patients with pelvic congestion syndrome may also have other venous abnormalities such as compression of their common iliac vein (known as May-Thurner anatomy) or left renal vein. Your interventional radiologist can discuss the significance of these with you at the time of your clinic appointment.
Who Performs an OVE?
Ovarian vein embolisation is usually done by an interventional radiologist, an endovascular specialist with extensive training in embolisation.
How does an OVE Procedure work?
An ultrasound is used to guide a tube into the vein at either the base of the neck or groin crease, then a catheter (thin plastic tube) is passed into the ovarian veins under x-ray control. Occasionally, deeper pelvic veins (tributaries of the internal iliac veins) may also need to be treated. The catheter will be passed down this vein into the pelvis where soft metal coils will be placed, with or without liquid sclerosant. Occasionally other agents such as glue can be used.
Is the procedure painful?
The procedure is performed under sedation and local anesthetic, so patients feel no pain during the procedure.
How long does an OVE Procedure take?
This procedure usually takes around 25 minutes and can usually be done with light or twilight sedation. After a 2 hour period of recovery, patients can go home the same day.
What are the side effects of OVE?
Some patients experience mild flank or pelvic discomfort, though this is well managed with medication. You can usually return to your usual activities after a day or so, though it is recommended to avoid heavy lifting or strenuous exercise for 5 -7 days after your procedure.
Risks of OVE
Rare risks of an OVE procedure include coil migration, bruise-related infection, or allergic reactions. However, OVE is generally considered low risk compared to surgery.
Does OVE affect fertility?
There is no data to suggest that OVE affects the menstrual cycle or fertility.
How effective is OVE?
Treatment of pelvic congestion syndrome with embolisation should provide pain relief for most women. Our team of interventional radiologists at VIRQ are experts in embolisation and have extensive experience treating women with pelvic congestion syndrome.
Visit our website to learn more about ovarian vein embolisation or speak with your doctor about a referral to VIRQ for an OVE procedure.