Pelvic Vein Embolization for Pelvic Congestion Syndrome

Pelvic congestion syndrome results from enlarged veins in the pelvis that can cause chronic pelvic pain.

At Henry Ford, our interventional radiologists perform a number of procedures to help address women’s health issues, including chronic pelvic pain. While pelvic pain may be due to a number of factors, one possible cause is pelvic congestion syndrome, which develops from enlarged and obstructed veins in the pelvic region that are similar to varicose veins. They develop when blood in weakened veins has begun to flow backward in the veins, resulting in stasis or poor flow out of the veins, causing further enlargement of the veins.

This pooling blood causes the veins to:

  • Swell
  • Become tortuous or twisted
  • Become painful

This can cause chronic pelvic pain and lead to other problems in the uterus, ovaries and vulva.

Pelvic congestion syndrome symptoms

Symptoms that may indicate pelvic congestion include:

  • Chronic pain (present for six months)
  • Pain in the pelvis, lower abdomen or lower back
  • Pain is worse when standing (at end of day), after sexual intercourse, during menstrual period or during pregnancy
  • Irritable bowel
  • Frequent urination
  • Developing varicose veins on buttocks or thighs, or visible varicose veins in the labial area

Pelvic congestion syndrome diagnosis

Pelvic congestion syndrome typically is diagnosed by excluding other causes. During diagnosis, your physician will perform one or more tests to rule out any other diseases and conditions, and diagnose pelvic congestion.

These tests may include:

  • CT: CT with contrast, scanned during the time period when the contrast is filling the veins, can show the extent of pelvic venous congestion very well. This is our preferred imaging method.
  • Pelvic venography: In this minimally invasive procedure, contrast dye is injected into the pelvic veins so that they can be viewed on an X-ray. Typically combined with treatment as opposed to a separate procedure.
  • MRI: This noninvasive test uses a magnetic field to image the structures in the pelvic area.
  • Ultrasound: In this test, sound wnaves are used to image the pelvic area. Ultrasound may be administered on the skin above the abdomen or through the vagina.

If you are diagnosed with pelvic congestion, your Henry Ford interventional radiologist may recommend that you undergo embolization of the enlarged veins. This means that the radiologist will close any enlarged vein or vein with reversal of blood flow direction.

What happens during the pelvic vein embolization procedure?

A pelvic embolization is an advanced procedure that uses fluoroscopy — a type of medical imaging that displays a live X-ray image on a monitor — to ensure accurate placement of the embolic agents.

During the pelvic vein embolization treatment:

  • Your skin is sterilized at the injection site.
  • You are administered a local anesthetic to numb the injection area. Many patients also receive sedation by IV to put them into a “twilight” state.
  • You are positioned on the fluoroscopy X-ray table.
  • Your interventional radiology physician makes a small incision in your groin area.
  • Your physician inserts a catheter (tube) into one of the blood vessels in your leg and guides it to the targeted vein in the pelvic area, using the fluoroscopic image for reference.
  • Once the catheter is positioned, the embolic agent (metal coil or other material) is placed to block the weak vein.
  • The catheter is removed.
  • The procedure typically takes about an hour.

If you have asthma, be sure to let us know during your initial clinic visit. The agent commonly used to sclerose (block off) veins can cause asthma symptoms in those who are predisposed.

Once the weak veins have been sealed, the blood should stop pooling in the veins — relieving the pressure and pelvic pain.

What happens after the procedure?

After your procedure, you will be moved to a recovery room and monitored by your care team. In most cases, these procedures are performed on an outpatient basis and you will go home the same day, although some patients stay overnight to recover following the procedure. In most cases, you can also resume normal activity immediately.

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