Up until the year 2000 we had looked at several different ways of treating this condition – but all of these older methods had major drawbacks or failure rates.
We had tried operating directly on the veins in the pelvis either by open surgery or by Laparoscopic (keyhole) surgery – but these approaches had been traumatic to the patients and had given fairly poor results.
After discussions with several experts, we decided the best way forward was to use ‘ Pelvic Vein Embolisation’
This is an x-ray technique where a needle is put into a vein and, under x-ray control, a thin tube called a catheter is pushed into the vein we wish to treat.
When it is in the correct place, a metal ‘coil’ or a special embolising material called ‘Gelfoam’ is pushed out into the vein.
Neither of these embolising techniques are new – both coils and Gelfoam have been in use for over 20 years in different areas of the body to block off blood vessels – so we know they are safe and effective.
For many years they have been used to block off male testicular veins – in the treatment of varicoceles – and there are several years of experience, by some specialist centres, in using these in ovarian veins.
However, it is not just the pelvic vein embolisation that is important, it is how it is done – see the techniques that we have developed over many years at The Whiteley Clinic.
Almost all of our patients with Pelvic Vein Reflux which cause the following, will need treatment.
Using the neck approach, the catheter can be positioned under X-ray control, into any of the veins that might be a problem.
In this case, the first X-ray image shows the catheter in the patient’s left ovarian vein.
The contrast (a ‘dye’ the X-ray can see) falls with the blood down the vein and into the Varicose veins of the pelvis – which lie around the ovaries, uterus, bladder and bowel.
These large varicose veins can be clearly seen on the X-ray.
The next image shows that the embolisation coils have been put in the ovarian vein – which is now blocked permanently.
The catheter has now been moved under x-ray guidance and has been positioned into the patient’s right sided veins.
This image actually shows that not only are the ovarian veins a problem in the patient, but the pelvic varicose veins are also coming from another vein – the Internal Iliac Vein on this side.
The final image shows three sets of embolisation coils – all completely and permanently blocking the veins that they are in.
Both ovarian veins are embolised, as is the patient’s right internal iliac vein.
By stopping the blood refluxing (falling back down these veins), the pelvic varicose veins should shrink away over a few weeks.
Any vulval varicose veins should also shrink away – and any veins in the legs can now be treated with a reduced chance of them coming back again in the future.
Any symptoms that have been due to the varicose veins in the pelvis (aching, heaviness etc) should slowly improve.
We perform a further trans-vaginal Duplex after 6 – 12 weeks to check whether the veins have been completely treated.
In about 1 in 100 patients, there might still be some reflux in one of the veins that might need one further embolisation attempt. However this is now very rare and most patients have a complete cure after the first embolisation.
(To see our excellent results of Pelvic Vein Embolisation, see: http://www.ncbi.nlm.nih.gov/pubmed/18756371)