What is ovarian vein coiling or ovarian vein embolisation?

Ovarian vein coiling (or ovarian vein embolisation) is a technique for blocking the ovarian vein if it becomes incompetent.  Incompetence occurs when the valves in the ovarian vein do not work and the flow is down into the pelvis (rather than out of the pelvis). It is one of the causes of pelvic congestion syndrome and may also cause varicose veins in the legs.  To treat this, one can block the vein completely to prevent the flow into the pelvis.  To block the incompetent vein, one can put special coils into the vein.  This blocks off the incompetent ovarian vein and causes it to become a thread of scar tissue.  the coils are made of a special metal core with fine fibres attached which irritate the vein wall so that it collapses down and blocks off.  The blood then drains through veins where the valves are working and the return out of the pelvis is improved.

What do I need to do to prepare for ovarian vein coiling or ovarian vein embolisation?

Generally the left ovarian vein is the problem, occasionally the valves in the right ovarian vein also fail to work.  Ovarian vein coiling is done in an angiogram suite (similar to where heart stents are done) in a hospital.  The coiling is done under local anaesthetic with a light sedation.  The is no preparation other than fasting for 6 hours.  Because you will have sedation, you will need someone to drive you home.  It is done as a day procedure.  If you would like, you can watch the screen during your procedure and see the ovarian vein embolisation while it is being done.

How is ovarian vein coiling done?

A needle is placed in the vein in the groin called the common femoral vein (the vein that carries blood from the leg).  A wire is then advanced up the veins in the pelvis and into the inferior vena cava.  A specially shaped catheter is passed over the wire and the wire passed into the renal vein.  Images are taken to confirm that the ovarian vein is dilated and incompetent (stretched up and the valves are not working).  The wire is then passed down the ovarian vein to the ovary.  The catheter is passed over the wire and the wire removed.  A sclerosant such as Aethoxysclerol is injected through the catheter to close the veins in the pelvis.  This is similar to injection treatment of varicose veins in the legs.

The coils are threaded through the catheter and deployed in the vein while the catheter is withdrawn.  This is done in a series of steps and depends on the length of each coil so that a total of 3-6 coils are deployed until the full length of the vein is blocked off.  We confirm that the vein is no longer open.  The catheter and wire are removed and pressure is applied for approximately 30 minutes to prevent bleeding.

What happens after ovarian vein coiling?

After the ovarian vein coiling has been done, you will go to recovery for an hour or so.  You can have something to eat and drink.  There may be some mild discomfort in the groin and there may be some bruising.  Some women will have back pain.  This is because the vein runs on the muscles in the back of the abdomen and there may be some inflammation.  The best management is to take an anti-inflammatory such as Ibuprofen and Paracetamol.  You should have a followup appointment 3-4 weeks after the coiling has been done.  There is no specific recovery period but expect to return to normal activities after 48 hours.

What are the possible complications of ovarian vein coiling?

  • Bleeding into the groin may occur and is managed by applying pressure.  It will cause a significant bruise
  • Deep venous thrombosis occurs rarely (less than 1:100).  It is managed with blood thinners after confirmation by venous ultrasound
  • Very rare complications include infection of the puncture site or of the coils.  That is managed with antibiotics
  • If there is any concern, contact The Art of Vein Care

 

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