Who performs an ovarian vein embolization?

Ovarian Vein Embolization: Performer and Procedure

Interventional radiologists perform ovarian vein embolization procedures using specialized endovascular techniques. 1

Procedure Overview

Ovarian vein embolization is an endovascular procedure performed by interventional radiologists to treat conditions such as:

• Pelvic congestion syndrome
• Pelvic venous insufficiency
• Ovarian vein reflux
• Pelvic-origin varicose veins

Procedural Details

The procedure typically involves:

1. Access: Femoral vein approach under conscious sedation
2. Catheterization: Selective catheterization of the ovarian veins
3. Embolization: Deployment of embolic materials such as:
   • Platinum coils
   • Stainless steel coils
   • Polyvinyl alcohol spheres
   • Sclerosing agents

Clinical Applications

Ovarian vein embolization is primarily used for:

• Chronic pelvic pain lasting >6 months with pelvic varicosities
• Gravity-dependent pelvic pain
• Postcoital pain
• Lower extremity or vulvar varicosities of pelvic origin

The procedure has demonstrated significant clinical efficacy with:

• 75% of women experiencing substantial pain relief 1
• Pain relief sustained for up to 5 years post-treatment 1
• Success rates of 80-90% in properly selected patients 2, 3

Potential Complications

While generally safe, complications may include:

• Post-embolization syndrome (transient fever, pain, nausea) 1
• Abdominal discomfort (reported in up to 14.8% of patients) 1
• Thrombophlebitis 1
• Non-target vessel embolization 1
• Coil migration (rare but reported) 4
• Recurrent varices 1

Institutional Context

The procedure is performed in specialized interventional radiology suites equipped with:

• Fluoroscopic imaging capabilities
• Specialized endovascular tools
• Monitoring equipment for conscious sedation

Multidisciplinary Approach

Patients are typically referred to interventional radiologists by:

• Gynecologists (for pelvic pain evaluation)
• Vascular surgeons (for varicose vein management)
• Primary care physicians (for chronic pelvic pain)

Prior to the procedure, patients should undergo comprehensive evaluation including:

• Cross-sectional imaging (preferably MRI or ultrasound) 1
• Exclusion of pregnancy and active pelvic inflammatory disease 1
• Gynecologic workup including Pap smear and/or endometrial biopsy if indicated 1

Follow-up Care

Post-procedure care includes:

• Close monitoring for 24-48 hours after discharge 1
• Pain and nausea management 1
• Follow-up at 3-6 months to assess treatment efficacy 1
• Imaging to evaluate fibroid volume reduction (if applicable) 1

In summary, ovarian vein embolization is a specialized interventional radiology procedure performed by interventional radiologists with expertise in endovascular techniques, offering a minimally invasive alternative to surgical management for appropriate patients with pelvic venous disorders.