Ovarian Vein Embolization Ovarian vein embolization is the most frequently cited treatment for pelvic venous disease, often in conjunction with sclerotherapy. In a meta-analysis of 21 prospective case series involving a total of 1,308 women, early substantial pain relief was observed in 75% of women undergoing embolization (including combinations of coil, glue, and sclerotherapy), generally increasing, and sustained over time. Repeat interventions were generally low, and, although there were few data on post-treatment impact on menstruation, ovarian reserve, and fertility, no concerns were noted. Overall, transient pain was common following foam embolization, and there was <2% risk of coil migration. Overall, data from studies that used a sclerosant suggest significant symptomatic improvement of approximately 75% [59]. Immediate success rates for the endovascular treatment of pelvic venous disease have been favorable with the low complication rate. In a study, most patients reported pain relief in symptoms for up to 5 years post-treatment [67]. In a study involving 11 embolization procedures for 10 women (1 patient had an additional embolization procedure), 3 women (30%) had mild recurrence of pain at midterm follow-up. Of 8 patients who complained of dyspareunia, 6 were cured [68]. Evidence of efficacy in a second embolization procedure is contradictory. One study notes that embolization of pelvic varices may be an effective treatment in a well-selected group; however, if there is no improvement after the initial embolization, a second procedure is unlikely to be effective [69]. In a second study, 4 patients required second embolization, 3 of whom reported improved symptoms [70]. In another study involving retreatment after pregnancy-related recurrence, repeat embolization was shown to eliminate recurrent reflux [71]. Complications of embolization procedures have been noted in up to 9% of patients.
Lower Extremity Chronic Venous Disease. Ovarian Vein Embolization Ovarian vein embolization is the most frequently cited treatment for pelvic venous disease, often in conjunction with sclerotherapy. In a meta-analysis of 21 prospective case series involving a total of 1,308 women, early substantial pain relief was observed in 75% of women undergoing embolization (including combinations of coil, glue, and sclerotherapy), generally increasing, and sustained over time. Repeat interventions were generally low, and, although there were few data on post-treatment impact on menstruation, ovarian reserve, and fertility, no concerns were noted. Overall, transient pain was common following foam embolization, and there was <2% risk of coil migration. Overall, data from studies that used a sclerosant suggest significant symptomatic improvement of approximately 75% [59]. Immediate success rates for the endovascular treatment of pelvic venous disease have been favorable with the low complication rate. In a study, most patients reported pain relief in symptoms for up to 5 years post-treatment [67]. In a study involving 11 embolization procedures for 10 women (1 patient had an additional embolization procedure), 3 women (30%) had mild recurrence of pain at midterm follow-up. Of 8 patients who complained of dyspareunia, 6 were cured [68]. Evidence of efficacy in a second embolization procedure is contradictory. One study notes that embolization of pelvic varices may be an effective treatment in a well-selected group; however, if there is no improvement after the initial embolization, a second procedure is unlikely to be effective [69]. In a second study, 4 patients required second embolization, 3 of whom reported improved symptoms [70]. In another study involving retreatment after pregnancy-related recurrence, repeat embolization was shown to eliminate recurrent reflux [71]. Complications of embolization procedures have been noted in up to 9% of patients.