Pelvic Congestion Embolization - What to Expect

If you’re suffering from chronic pelvic pain, you’re not alone. This common condition affects up to 15% of women in reproductive age. Despite its prevalence, not everyone with the disorder experiences symptoms. Among those who suffer from chronic pelvic pain, about 30% are diagnosed with pelvic congestion syndrome. While there are several treatment options, this article focuses on pelvic congestion embolization and what to expect. So, let’s get started.

What causes pelvic congestion syndrome (PCS)?

Pelvic congestion is a painful condition commonly resulting from ovarian vein malfunction, leading to varicose veins in the pelvic region. This happens when the vein valves, which normally assist in returning blood to the heart against gravity, weaken and fail to close properly. Consequently, blood flows backward and accumulates in the veins, causing pressure and swelling. Diagnosis can be performed using several techniques, such as pelvic venography, CT scans, MRI, and pelvic or transvaginal ultrasound.

Once you’ve received a diagnosis of pelvic congestion syndrome, your doctor may recommend ovarian vein embolization to rid you of pain and help you get your life back on track.

What is ovarian vein embolization?

Ovarian vein embolization is a minimally invasive treatment for pelvic congestion, a painful condition caused by enlarged and malfunctioning veins in the abdomen and pelvis. This procedure alleviates pain by sealing off the abnormal veins, preventing them from filling with blood.

You should inform your doctor if you think you might be pregnant and discuss any recent illnesses medical conditions, allergies, and medications you are taking, including herbal supplements and aspirin. You may be instructed to stop taking aspirin, vitamin E, nonsteroidal anti-inflammatory drugs (NSAIDs), or blood thinners several days before your procedure.

Pelvic congestion embolization and what to expect during the procedure

Using X-ray imaging and a contrast material to visualize the blood vessel, an interventional radiologist inserts a catheter through the skin into a blood vessel and guides it to the treatment site. Once the position is confirmed, typically with IV contrast, a synthetic material or medication known as an embolic agent is delivered through the catheter and placed within the abnormal vein(s).

Permanent embolic agents work by physically blocking the blood vessels and causing scar tissue to form, which is crucial for treating conditions like refluxing veins that would recur if the embolic agent were to dissolve.

A step-by-step guide to the embolization procedure

1. Preparation and imaging: The patient is given a mild sedative to make the procedure more comfortable. The interventional radiologist uses x-ray imaging and contrast material to locate the exact position of the abnormal vein.
2. Catheter insertion: A catheter is inserted through the skin into a blood vessel.
3. Advancing the catheter: The catheter is carefully guided to the treatment site using image guidance.
4. Position confirmation: The position of the catheter is confirmed, usually with the help of IV contrast.
5. Delivery of embolic agent: A synthetic substance or medication known as an embolic agent is administered through the catheter and carefully placed within the abnormal vein(s).
6. Blocking the vein: The embolic agent physically blocks the blood vessels.
7. Formation of scar tissue: The embolic agent induces the formation of scar tissue within the vessel, which is essential for preventing the recurrence of conditions like refluxing veins.

Discomfort is one of the most common side effects of embolization and can be controlled with over-the-counter oral medications or prescribed medication through an IV. Heavy lifting and strenuous activity should be avoided for about a week.

It can take up to three months before it is determined whether the procedure has controlled or eliminated the symptoms of PCS.

The benefits of ovarian vein embolization vs the risks

Benefits

Ovarian vein embolization is a highly effective treatment for pelvic congestion caused by faulty ovarian veins. Success rates of 85 percent and higher have been reported globally in women undergoing this procedure.

Embolization is far less invasive than traditional open surgery, leading to fewer complications and a shorter hospital stay (patients typically return home the same day). It involves minimal blood loss compared to conventional surgical methods and does not require a visible surgical incision.

This technique can address abnormal veins in the pelvis that would otherwise necessitate major surgery. Instead of a surgical incision, only a small nick in the skin is made, negating the need for stitches.

Risks

There is a minimal risk of allergic reactions to the sedatives or contrast material used during the procedure.

Any procedure involving catheter insertion into a blood vessel carries inherent risks, including vessel damage, bruising, bleeding at the puncture site, and potential infection. Your doctor will take precautions to minimize these risks.

While rare, there is a slight possibility of the embolic agent lodging in the wrong place, potentially compromising the oxygen supply to normal tissue.

Even with antibiotic prophylaxis, there's still a risk of infection following embolization.

In some cases, the pain may temporarily worsen (due to inflammation in the week following the procedure) before gradually improving.

What are the constraints of ovarian vein embolization?

Achieving successful embolization without harming normal tissue necessitates precise catheter placement. This entails positioning the catheter tip in such a way that embolic material is deposited solely in vessels supplying the abnormal area. In a small percentage of instances, technical constraints may render the procedure unfeasible due to the inability to position the catheter appropriately.

Additionally, over time, the development of additional abnormal veins may contribute to symptom recurrence.

Hopefully, this article has answered all of your questions about pelvic congestion syndrome, embolization, and what to expect during and after the procedure.

Get in touch

If you are suffering from intermittent or constant pelvic pain and suspect you may have pelvic congestion syndrome, contact the experienced team at MINT Stl. We provide ovarian vein embolization on an outpatient basis at our offices and can tailor a treatment plan based on the severity of your condition.