Veins which are suitable for pelvic vein embolisation
- vaginal varicose veins (varicose veins in the vagina)
- vulval varicose veins (varicose veins at the entrance of the vagina – the vulva)
- leg varicose veins coming from the pelvis
- haemorrhoids (commonly known as piles)
The ovarian veins are very long veins that start at the ovaries and drain blood up to veins more or less at the level of the kidneys. When the valves in these veins stop working, blood falls back down the ovarian veins (ovarian vein incompetence or ovarian vein reflux) causing varicose veins in the pelvis (pelvic congestion syndrome).
The internal iliac veins are very short and are often overlooked when veins are investigated. However research from the UK has shown that internal iliac vein reflux can allow blood to reflux into vaginal, vulval and leg varicose veins and also into haemorrhoids (piles).
The best way to diagnose which of these veins are not working and therefore need embolisation, is to perform a transvaginal duplex ultrasound scan at a specialist unit. Nonspecialist units often use MRI, CT scanning or venography. Unfortunately none of these techniques are as accurate as transvaginal duplex ultrasound scanning when performed by a properly trained expert.
When a patient has a problem with pelvic congestion syndrome, vaginal varicose veins, vulval varicose veins, some leg varicose veins from the pelvis and some haemorrhoids from the internal iliac veins, a transvaginal duplex ultrasound scan shows which of the veins are involved. Of the four veins described above, any number of them can be involved and occasionally all four can be involved.
Any of these for veins are suitable for pelvic vein embolisation (or embolization).