Left ovarian vein embolization in pelvic congestion syndrome: technique and midterm results

Background Pelvic congestion syndrome is defined as intermittent or constant pain that persists for at least 3-6 months, is localized in the abdomen or pelvis, is not associated with pregnancy, is not limited to any period of menstrual cycle or intercourse, and is severe enough to cause functional disability or require treatment. This condition has been recognized as a potential cause of chronic pelvic pain (CPP) in women of childbearing age. The aim of this study was to detect the efficacy of embolization of ovarian veins by assessing the adequacy of closure of incompetent pelvic veins and abolishment of venous reflux in the addressed ovarian veins. Patients and methods A single-center prospective study was conducted on 14 women of childbearing age complaining of CPP associated with dysmenorrhea, dyspareunia, and\or vulvar varicosity, lower limb pain. All patients underwent lower limb venous duplex as well as pelvis duplex to assess the presence of dilated and refluxing ovarian vein more than 6mm in diameter. Gynecological causes of pelvic pain were excluded; all patients underwent venography in an angiosuite to confirm the diagnosis of dilated ovarian vein and presence of parametrial varicosities. Embolization of ovarian vein and associated pelvic veins was done using foam sclerotherapy with polidocanol and coiling of the ovarian vein with coils ranging from 8 to 12mm in diameter. Results In our study, there was a statistically significant improvement in symptoms in our patients after coiling during the follow-up compared with before coiling, including CPP (P=0.002), lower limb pain (P=0.003), dyspareunia (P=0.003), and dysmenorrhea (P=0.002). Conclusion The embolization of ovarian vein is feasible, safe, and effective with high rates of success and clinical improvement in the treatment of pelvic congestion syndrome.