Pelvic Vein Embolisation in the Management of Varicose Veins

Abstract

Pelvic vein incompetence is common in patients with atypical varicose veins, contributing to their recurrence after surgery. Therefore, refluxing pelvic veins should be identified and treated. We present our experience with pelvic vein embolisation in patients presenting with varicose veins. Patients presenting with varicose veins with a duplex-proven contribution from perivulval veins undergo transvaginal duplex sonography (TVUS) to identify refluxing pelvic veins. Those with positive scans undergo embolisation before surgical treatment of their lower limb varicose veins. A total of 218 women (mean age of 46.3 years) were treated. Parity was documented in the first 60 patients, of whom 47 (78.3%) were multiparous, 11 (18.3%) had had one previous pregnancy, and 2 (3.3%) were nulliparous. The left ovarian vein was embolised in 78%, the right internal iliac in 64.7%, the left internal iliac in 56.4%, and the right ovarian vein in 42.2% of patients. At follow-up TVUS, mild reflux only was seen in 16, marked persistent reflux in 6, and new reflux in 3 patients. These 9 women underwent successful repeat embolisation. Two patients experienced pulmonary embolisation of the coils, of whom 1 was asymptomatic and 1 was successfully retrieved; 1 patient had a misplaced coil protruding into the common femoral vein; and 1 patient had perineal thrombophlebitis. The results of our study showed that pelvic venous embolisation by way of a transjugular approach is a safe and effective technique in the treatment of pelvic vein reflux.

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

“…Eleven were included from the review of the diagnostic accuracy of non-invasive technique 23,[36][37][38][39][40][41][42][43][44][45] and 21 were included from the review of embolisation; 15,31,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] one study was included in both reviews. 65 A summary of the inclusion criteria from the selected studies is given in Table 1.…”

“…23,36,37,43,[45][46][47][48][53][54][55]61,62 These studies invariably discussed definitions of PCS in the introduction section of the report, but it was not clearly stated which pain symptoms defined eligibility for the study, or else the report described the prevalence of pain symptoms in terms of percentage of patients reporting each symptom but did not indicate whether or not any were essential. In 5 of these 12 studies, 38,39,[46][47][48] the study population were women referred for screening or treatment of varicose veins of the leg.…”

“…Ten studies simply stated that their populations had pelvic varices, sometimes described as dilated or voluminous. 38,41,47,50,[52][53][54][55][56]65 More studies reported an OV diameter, above which the vein was considered to be dilated, but this threshold varied considerably, from > 4.5 mm 67 to > 10 mm, 57,58 with > 5 mm being the most frequently cited. 40,42,43,59,60 Halligan et al grouped patients into three ranges of pelvic vein diameter without specifying a threshold.…”

“…There are many ways to describe the observations of the venous blood flow, converging on general terms such as congestion, insufficiency and reflux. A non-descript term of congestion was used in nine studies, 41,47,50,[52][53][54][55][56]65 sometimes with qualifying terms such as stasis or distension, and categories of severe or moderate, but without any thresholds for such grouping. Descriptions of venous reflux were marginally better, with bidirectional or retrograde flow being indicative of reflux.…”

Pregnancy after embolization of ovarian varicocele: report of two cases

“…Pelvic US (transabdominal or transvaginal) is often the first-line examination (10,11). With CT, the tubular structure of dilated ovarian veins and the pattern of their enhancement after intravenous administration of contrast medium allow the investigator to distinguish them from adnexal masses or lymphadenopathy (12,13).…”