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Ovarian Vein Embolization

Last updated Feb. 6, 2019

James Heilman, MD

Ovarian Vein Embolization is used for the treatment of pelvic congestion syndrome, arteriovenous malformation, varicose veins, and other type of bleeding in women. This is an ultrasound image showing a very large (9cm) fibroid of the uterus, which is causing pelvic congestion.


Background Information:

What are the other Names for the Procedure?

  • Embolization of Ovarian Vein

What is Ovarian Vein Embolization radiology procedure? (General Explanation)

  • Ovarian Vein Embolization is used for the treatment of pelvic congestion syndrome, arteriovenous malformation, varicose veins, and other type of bleeding in women
  • Pelvic congestion syndrome is also known as ovarian vein reflux. It is a painful condition resulting from varicose and bulging veins in the pelvic area
    • In this condition, valves of veins which help return blood from the pelvic area to the heart are weakened, resulting in pooling and pressure of blood in the pelvis causing pain
    • Pelvic congestion syndrome is usually diagnosed using venography, MRI, or transvaginal ultrasound        
  • Ovarian Vein Embolization is a procedure that is used to shut down these problematic veins, so that blood does not get collected in the pelvic area

What part of the Body does the Procedure involve?

The groin area is involved in the Ovarian Vein Embolization procedure.

Why is the Ovarian Vein Embolization radiology procedure Performed?

  • Ovarian Vein Embolization is used for the treatment of pelvic congestion syndrome in women
  • It prevents pooling of blood in pelvis by closing-off faulty veins in pelvis area and relieves the pain

What is the Equipment used? (Description of Equipment)

The following equipment is used for Ovarian Vein Embolization:

  • Catheter: It is a thin, plastic tube that is inserted through the femoral vein to reach faulty veins in the pelvis area
  • Fluoroscopy is used for image guidance and to guide the catheter to the faulty veins.
    • X-ray machine is used in fluoroscopy
    • Fluoroscopy basically converts x-ray images into real-time video images          
  • Embolic agents are used to close-off the faulty blood vessels. Various embolic agents, such as gel, foam, metal coils, liquid gels, or liquid sclerosing agents, can be used for this purpose

What are the Recent Advances in the Procedure?

There have been no recent advances in the Ovarian Vein Embolization procedure.

What is the Cost of performing the Ovarian Vein Embolization radiology procedure?

The cost of Ovarian Vein Embolization procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding ovarian vein embolization   procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.ncbi.nlm.nih.gov/pubmed/24876367 (accessed on 03/10/2015)

http://www.ncbi.nlm.nih.gov/pubmed/24840963 (accessed on 03/10/2015)

http://www.ncbi.nlm.nih.gov/pubmed/24618909 (accessed on 03/10/2015)

Prior to Ovarian Vein Embolization radiology procedure:

How does the Ovarian Vein Embolization radiology procedure work?

  • A catheter is inserted through the femoral vein into the patient’s groin region
  • X-ray imaging and contrast material is used to localize the faulty vein in the pelvic area
  • Once the faulty vein is localized, embolic agents are placed in the vein to seal it. After a certain period of time, a scar is created around the embolic agent and closes-off the vein permanently

How is the Ovarian Vein Embolization radiology procedure Performed?

The Ovarian Vein Embolization procedure is performed in the following manner:

  • Ultrasound, CT, or MRI scan is performed prior to the procedure, to locate the faulty veins in the pelvic area
  • The patient is positioned on the examination table and his/her vital signs are monitored
  • An IV line is inserted into the patient’s arm vein to inject sedative medications, if required
  • The groin area, where the catheter is to be inserted, is sterilized and cleaned
  • The physician palpates the groin area to locate the femoral vein, or uses an image guidance technique to find it
  • Once the femoral vein is located, a small incision is made, after injecting a local anesthetic, to insert the catheter
  • A contrast material is injected through the catheter and image guidance is used to advance the catheter to find the site of bleeding and varicose veins
  • An embolic agent is injected through the catheter, once the site of varicose veins is confirmed
  • Additional angiograms are taken to check the correct placement of the embolic agent, and if the blood flow has stopped
  • The catheter is removed at the end of the procedure and pressure applied at the insertion site to arrest any bleeding; no sutures are necessary
  • The patient may have to stay in bed for 6-8 hours and should avoid bending over, to avoid additional bleeding

Where is the Procedure Performed?

An Ovarian Vein Embolization procedure is performed as an outpatient procedure at a hospital, or a surgery center.

Who Performs the Procedure?

An interventional radiologist performs the Ovarian Vein Embolization procedure.

How long will the Procedure take?

An Ovarian Vein Embolization procedure may take from 30 minutes to several hours depending upon the severity of the condition.

Who interprets the Result?

An interventional radiologist interprets the results of the procedure.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Peritoneal Port Insertion procedure:

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
  • Do inform the medical professional if you have a history of any medical conditions such as a heart disease, asthma, diabetes, or kidney disease
  • Patients should stop taking anti-coagulation medications (if any taken) prior to the procedure, including aspirin and warfarin, according to their physician’s instruction
  • Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
  • Lab studies may be performed prior to the procedure to check kidney function
  • It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the x-ray
  • Women should notify the physician if they are pregnant or breastfeeding their child, as many such procedures may not be performed on pregnant women
  • Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations before the preparation sessions
  • The patient may be asked to avoid eating or drinking several hours before the procedure

What is the Consent Process before the Procedure?

A physician will request your consent for Ovarian Vein Embolization procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Ovarian Vein Embolization procedure:

  • The procedure is a highly effective and successful procedure in controlling bleeding and treating pelvic congestion syndrome
  • It is much less invasive and has less complications than an open surgery
  • It can be used to successfully treat varicose veins, vascular malformations, and tumors

Following are the risks of the Ovarian Vein Embolization procedure:

  • There is a slight risk of infection at the site of catheter insertion due to skin incision
  • Contrast material used during the procedure may cause allergic reactions in certain individuals
  • There is a slight risk of cancer, if excessive radiation is used during the procedure
  • Catheter insertion in vein may damage blood vessel and cause severe bleeding
  • In rare cases, if embolic agent is placed in the wrong vein, it may cause ischemia (deprivation of blood to normal tissues)

What are the Limitations of the Ovarian Vein Embolization radiology procedure?

In order for Ovarian Vein Embolization to be successful, the catheter must be placed at the precise position. If the catheter is not placed at the precise location, the embolic agent may not be effective.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

  • What is an Ovarian Vein Embolization procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • What are the possible side effects from the procedure? How can I minimize these side effects?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
  • Is there any medication that needs to be taken for life after the procedure?
  • What are the costs involved?

During the Ovarian Vein Embolization radiology procedure:

What is to be expected during the Ovarian Vein Embolization radiology procedure?

The following may be expected during the Ovarian Vein Embolization procedure:

  • The patient may feel a slight sting when the needle is inserted into the vein and the groin area is numbed using a local anesthetic
  • If patient is sedated during the procedure, patient will feel relaxed and sleep
  • The patient’s vital signs are monitored through various devices
  • If general anesthetics are used with a breathing tube, the patient may have a sore throat for a couple of days
  • As the contrast material is being injected, the patient will feel a warm sensation in the body
  • Some may experience pain after the procedure, which can be controlled using prescriptive oral medication
  • Patients are normally required to stay in overnight in the hospital (for a period of 24 hours); those with severe side effects may require longer hospitalization time

What kind of Anesthesia is given, during the Procedure?

Sedatives or general anesthetics are used during the Ovarian Vein Embolization procedure.

How much Blood will you lose, during the Procedure?

Since the procedure is a minimally-invasive one, the blood loss involved is minimal.

What are the possible Risks and Complications during Ovarian Vein Embolization radiology procedure?

  • Catheter insertion into the vein may damage the blood vessel and cause severe bleeding
  • Rarely, a wrong placement of embolic agents in the blood vessel could deprive blood supply to normal/healthy tissues

What Post-Operative Care is needed at the Healthcare Facility after the Ovarian Vein Embolization radiology procedure?

  • No specific post-operative care is needed at the healthcare facility after the Ovarian Vein Embolization procedure
  • Patients are advised to stay in bed for a few hours after the procedure and advised not to bend over, to prevent bleeding

After the Ovarian Vein Embolization radiology procedure:

What is to be expected after the Ovarian Vein Embolization radiology procedure?

  • Patients have to stay in hospital overnight for 24 hours; those with severe side effects may require longer hospitalization
  • Patient can resume normal activities within a week after the procedure

When do you need to call your Physician?

Patient should call their physician after Ovarian Vein Embolization, in the following situations:

  • If the pain persists even after taking oral pain medications
  • If patient experiences bleeding from the catheter insertion site that does not stopped by applying pressure
  • If any signs of infection at the site of catheter insertion is developed, such as high fever, redness, or warmth at the site

What Post-Operative Care is needed at Home after the Ovarian Vein Embolization radiology procedure?

  • No specific post-operative care is needed at home after the procedure
  • Patients can resume their normal activities within a week of the procedure

How long does it normally take to fully recover, from the Procedure?

  • Ovarian vein embolization may take few days to fully recover.
  • Patient can resume normal activities within a week after the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Ovarian Vein Embolization procedure does not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Ovarian Vein Embolization radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital, where the procedure is performed
  • Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Ovarian Vein Embolization procedure is performed.

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: March 24, 2015
Last updated: Feb. 6, 2019