Pelvic vein embolisation: the procedure explained

Pelvic vein embolisation is a medical procedure to treat pelvic congestion syndrome by blocking abnormal veins using a catheter to alleviate symptoms like pain and discomfort. Renowned consultant interventional radiologist Dr Aidan Shaw discusses the condition, including how it is performed and what risks are involved.

What is pelvic vein embolisation, and when is it typically recommended as a treatment option?

Many women worldwide may have dilated veins in their pelvis, but this doesn't necessarily lead to symptoms. When patients do experience symptoms, it indicates pelvic venous congestion. Symptoms include chronic pelvic pain lasting at least six months, ranging from mild to severe.

Severe cases can hinder daily activities such as lifting children or necessitate opioid use, significantly impacting quality of life. Other symptoms may involve pain on the left or right side, extending to the back or legs, pain or discomfort during sex, and extremely painful periods. Some women may also experience potential effects on bladder and bowel functions.

Can you explain the pelvic embolisation procedure in detail, including how it is performed?

Patients can experience a range of symptoms, and every woman I've treated has presented a unique variation. When it comes to treatment options, surgery, like ligating the ovarian vein, is a possibility, but its success rates are not as promising as pelvic venous embolisation. This day case procedure has the potential to significantly improve the lives of women dealing with chronic pelvic pain – it's a real game-changer.

To ensure comfort, I perform this procedure under local anaesthesia with some sedation. This small puncture into the neck vein is guided by x-rays to manoeuvre a catheter into the problematic dilated veins in the pelvis. Blocking these veins with sclerosant and small metal coils is the next step.

The procedure usually takes about 30 minutes, sometimes up to an hour for more complex cases, and is generally well-tolerated. Some patients may experience pelvic discomfort, especially when sclerosant foam is used, but interestingly, this can be a positive sign that the procedure will be effective, mimicking their symptoms on the table. While responses vary, those experiencing a bit of discomfort during the procedure often have a good symptomatic response.

Any discomfort felt by patients will usually have eased off by the time the operation is finished. Patients are then taken to a recovery area, where additional painkillers are provided if needed. Discharge occurs a few hours later, once the sedation has worn off. While most patients don't experience much discomfort upon discharge, we still provide painkillers just in case.

What are the risks involved?

While the procedure carries some minor risks, my experience suggests these risks are around 2 to 3%, and I have not encountered any major complications in my practice. The potential complications I discuss with patients include slight risks of bleeding or bruising due to the puncture in the neck vein, as well as risks of infection.

However, the primary concern for patients tends to be the placement of metal coils within the vein, as there is a possibility of migration to the kidney vein, heart, or lungs. To mitigate this risk, I advise patients to avoid strenuous exercise for at least a week to allow the coils to be securely set in place.

Although coil migration is a concern for patients, it's essential to note that, in my practice, I haven't experienced such an occurrence. Nevertheless, I am aware that it can happen. Another consideration is thrombophlebitis, which may cause post-procedure pain. We address this by providing patients with painkillers. Additionally, there is a risk of symptom recurrence or venous congestion symptoms resurfacing, known as recurrence, which is a potential late complication.

What is the recovery process like following pelvic vein embolisation, and how long does it usually take to recover?

While the majority of patients tend to recover swiftly from this procedure, it's important to recognise the uniqueness of each individual. Every patient I treat exhibits distinct characteristics. Some may experience discomfort the following day, and rarely, this discomfort can be quite intense, requiring the use of painkillers. However, the vast majority of patients with this condition typically recover quite rapidly.

I usually advise patients to plan for a recovery period of at least one to two weeks, though I acknowledge that this timeframe may be a bit conservative. It's worth noting that some individuals may require a slightly longer recovery time than others. As for the procedure's impact, some women may notice an immediate improvement in their pain, expressing relief right after completion.

However, others may take a bit longer to experience the positive effects. I've encountered cases where women, over a couple of months, suddenly wake up one morning to find that their pain has disappeared. The key takeaway is that everyone is unique, both in their recovery process and response to the procedure. Despite these individual differences, the vast majority of patients tolerate the procedure well, often with minimal or no symptoms. Moreover, if the procedure is effective, most patients tend to notice a rapid and significant improvement.

What are the expected outcomes and success rates?

In my practice, even in the most ideal cases where patients have both dilated veins on imaging and classical symptoms, the procedure achieves success in approximately 80% of cases. While it's tempting to make promises about its efficacy, I believe it's crucial to convey to patients that it's not a guaranteed outcome; we can't guarantee a 100% success rate.

Despite this, I find the 80% success rate to be quite remarkable. This procedure has the potential to transform a patient's life significantly, and it's achieved through a minimally invasive approach without the need for general anaesthesia, coupled with very low complication rates. When weighing the risks against the benefits, I firmly believe that the benefits far outweigh the potential risks.

If you would like to book a consultation with Dr Shaw, simply visit his Top Doctors profile today.