What is the ovarian embolization procedure?

Ovarian Embolization Procedure: A Minimally Invasive Treatment for Pelvic Venous Disorders

Ovarian vein embolization is a minimally invasive procedure that effectively treats pelvic venous disorders with substantial pain relief observed in approximately 75% of women, with benefits generally increasing and sustained over time. 1

Procedure Overview

• Ovarian vein embolization is performed percutaneously through a catheter-based approach, typically accessing the venous system through the femoral vein 2
• The procedure involves the selective occlusion of refluxing ovarian veins using embolic materials such as:
  • Metallic coils (stainless steel or platinum)
  • Sclerosing agents (often used in combination with coils)
  • Glue (enbucrilate) in some cases 1, 3
• Most procedures focus on treating only the refluxing veins, typically the left ovarian vein, unless the right ovarian vein or internal iliac vein tributaries are also refluxing 4

Indications

• Primary indication is pelvic congestion syndrome characterized by chronic pelvic pain 1
• Other symptoms that may improve with treatment include:
  • Dyspareunia (painful intercourse)
  • Lower extremity varicose veins of pelvic origin
  • Vulvar varicosities 1, 5
• Diagnostic venography is typically performed immediately before embolization to confirm venous reflux 5

Procedural Technique

• The procedure is performed under local anesthesia with moderate sedation 2
• Access is typically obtained through the femoral vein, though jugular, basilic, or cephalic approaches may also be used 6
• Selective catheterization of the ovarian veins is performed under fluoroscopic guidance 3
• Venography confirms the presence of venous reflux before proceeding with embolization 5
• Embolic materials are deployed to occlude the refluxing veins:
  • Most cases require only about four pushable coils when using the "keep-it-simple" approach 4
  • Some practitioners use a "sandwich" technique with sclerosing foam between coils 4

Efficacy and Outcomes

• Meta-analysis of 21 prospective case series involving 1,308 women showed:
  • Early substantial pain relief in 75% of women
  • Benefits generally increasing and sustained over time 1
• Long-term follow-up studies demonstrate:
  • Pain relief sustained for up to 5 years post-treatment in most patients 1
  • Complete symptom resolution in 58.5% of cases in one study 3
  • Clinical success rates of 84-89% at follow-up periods ranging from 6 weeks to 5 years 4
• Improvement in quality of life with significant reduction in pain scores (average reduction of 5.2 points on a visual analog scale in one study) 4

Complications and Post-Procedure Care

• Complications are generally rare (reported in up to 9% of patients) and include:
  • Post-embolization abdominal discomfort (reported in up to 14.8% of patients)
  • Thrombophlebitis
  • Non-target embolization
  • Coil migration (risk <2%)
  • Recurrent varices 1
• Post-procedure restrictions similar to other embolization procedures:
  • Avoid heavy lifting (>10 pounds) for 7-10 days
  • Avoid sexual intercourse for 1-2 weeks 7
• Post-embolization syndrome (fever, pain, nausea) is common but typically resolves within the first week 7

Follow-Up Care

• Close monitoring for the first 24-48 hours after discharge for pain control and potential complications 7
• Follow-up evaluation at 3-6 months to assess treatment efficacy 7
• Some patients may require repeat embolization:
  • Evidence regarding efficacy of second procedures is mixed
  • Some studies suggest limited benefit if the initial procedure was ineffective
  • Others report improvement in symptoms with repeat procedures, particularly after pregnancy-related recurrence 1

Special Considerations

• Bilateral versus unilateral embolization:
  • Most patients (73%) require only unilateral ovarian vein embolization 4
  • No significant difference in clinical outcomes has been observed between patients with bilateral versus unilateral embolization 3
• Alternative treatments include:
  • Surgical options such as ovarian vein ligation (laparoscopic or open)
  • Left renal vein stenting for cases related to nutcracker syndrome 1
• Important to exclude other causes of pelvic pain before proceeding with embolization 1