Pelvic Congestion Syndrome Embolization

Chronic pelvic pain is not uncommon among women during their childbearing years. After eliminating other potential causes of this non-cyclical pain, your doctor may arrive at a diagnosis of pelvic congestion syndrome. The severe, dull, and ongoing pain that women with this condition suffer can be traced to varicose veins that develop in the pelvis and ovaries. Veins become “varicose” when their walls or valves are stretched or weakened by the pressure of the blood flowing through them, and blood collects in them. Interventional radiologists use a treatment called embolization to close off these weakened veins and to re-route blood circulation around them.

What is embolization?

Embolization is a minimally invasive procedure in which we occlude, or block, varicose veins in the pelvis. Using imaging guidance our interventional radiologists block blood flow to the veins by closing them off with a tiny coil and/or a synthetic material called an “embolic agent.” Once the flow of blood through the veins is stopped most women experience a significant reduction of their pain.

How do I get ready for the procedure?

On the night before the procedure eat a light meal, then do not eat or drink anything after midnight. We will provide you with more detailed information about which medications you may take in days before and on the morning of the procedure. Some women remain in the hospital overnight after undergoing embolization; we will discuss this possibility with you before the procedure.

What will happen during the procedure?

When you arrive at the interventional radiology suite, we will have you lie on a table then we will insert an intravenous line in your arm and give you conscious sedation to relax you and block any pain. Using image guidance (usually fluoroscopy, a kind of X-ray “movie”), we will insert a catheter (a long, thin, hollow plastic tube) through a small incision in your groin and thread it to the veins that are potentially causing the pain. We will inject a contrast dye through the catheter into the veins to highlight them on the fluoroscopy image, making it possible to tell if these veins have become enlarged. This imaging procedure is called a venogram. If we identify any varicose veins we can treat them immediately after the venogram by placing a coil and/or embolic agent (FDA-approved polyacrylamide microspheres with a gelatin coating) in the vein to block the blood flow. After the procedure is competed we will remove the catheter. The procedure takes from 30 minutes to several hours depending on how many veins require treatment. If there are too many veins to treat during one procedure we perform a second embolization procedure three to six weeks after the first one.

Are there any risks?

Rare potential complications of embolization include perforation of a vein, a blood clot in a vein, and migration of the embolic agent from its original site.

After the procedure

Most women remain in the interventional radiology suite for several hours of rest and observation following embolization. In some cases, you may have to stay longer, or even overnight in the hospital. Some degree of pain is common following pelvic vein embolization, and we will control your medication with an oral or intravenous pain medication. You should be able to resume your normal activities within a week.