Advantages and disadvantages of pelvic vein embolisation
Pelvic vein embolisation (or embolization) using the technique on the previous page (called the “transjugular route” – using a neck vein), and using coil embolisation (or embolization) has proven to be very successful.
To work out the advantages and disadvantages of this technique, one has to first to think about what the alternatives are.
The commonest alternative is to ignore the pelvic vein reflux completely, and as most women will know, it is very rare that any investigation or treatment at all is offered to them if they suffer from:
pelvic congestion syndrome (a combination of any of the following: a dragging in the pelvis particularly during the period, discomfort on sexual intercourse, irritable bladder, irritable bowel)
vaginal varicose veins
leg varicose veins in the upper thigh
As such, although research at The Whiteley Clinic in the UK has shown that one in seven women with leg varicose veins have this problem, in normal venous clinics, pelvic veins are almost never investigated nor treated. It is a very sad thing to have to also note here that very few gynaecologists recognise pelvic congestion syndrome and a great many tell women with the symptoms that there is “nothing wrong with them” once they have excluded ovarian cysts, infection, adhesions, endometriosis and other well recognised gynaecological disorders. A great many such women only get diagnosed when a venous expert or radiologist notices the enlarged refluxing veins in their pelvis on any of their scans.
Therefore the advantages of pelvic vein embolisation (or embolization) over ignoring it are that the symptoms get treated, and leg varicose veins that are caused by pelvic vein reflux can be cured, whereas if the pelvic veins are not embolised (or embolized) they are likely to keep coming back year after year.
In the past, some pioneering surgeons who recognised this as a problem tied the veins in the pelvis either via a major operation or put clips on the veins through a laparoscope. Both of these techniques are far more invasive and have far higher risks for the patients and are rarely as effective as embolising (or embolizing) the veins from the inside guided by x-rays.
When coils are compared to other techniques such as foam sclerotherapy, they are more expensive but have an excellent long term success rate.
Different types and versions of pelvic embolisation (or embolization)
Pelvic embolisation (or embolization) is most successfully performed as outlined in the “how pelvic embolisation (or embolization) is performed” page of this website.
As noted there, some doctors do try to use different approaches such as entering the venous system by veins in the groin or veins in the arm. Veins in the groin leave the equipment facing the wrong way and make the operation far more difficult and less likely to be successful. Veins in the arm can be used but lead to a higher risk of the arm vein blocking off later (thrombophlebitis) as it is much more narrow.
Metal coils are currently the optimal way of performing the embolisation (or embolization) itself. Foam sclerotherapy is less effective in the medium to long-term as the veins are too large for the sclerotherapy to be effective. There are some other embolisation devices and also another technique called “gel foam” that may well be successful in the long-term, particularly if combined with coil embolisation, or put in place with an inflatable balloon.
Pelvic vein embolisation (or embolization) is relatively new in medicine in the treatment of pelvic varicose veins that can cause vaginal, vulval and leg varicose veins. As more interest increases in this area, and as more vein surgeons, phlebologists and hopefully gynaecologists and family doctors recognise this condition, more research will be performed and newer techniques will be developed.
This website was last updated on 11/10/16.