Pelvic vein embolisation (PVE)
Pelvic vein embolisation (PVE) closes off problem veins in the pelvis, relieving the pain of pelvic venous congestion syndrome (PVCS).
PVE may also be used to treat varicose veins in the legs arising from problems within the pelvis.
Contents
What is pelvic vein embolisation (PVE)?
Pelvic venous congestion syndrome (PVCS) is a painful condition resulting from faulty valves within the veins in the pelvis (most typically the ovarian vein). Pelvic vein embolisation (PVE) treatment closes off these problem veins so that they can no longer enlarge with blood, thus relieving the pain.
PVE may also be used to treat the following conditions:
- Vulval varicose veins
- Vaginal varicose veins
- Leg varicose veins arising from vein problems within the pelvis
PVE is a minimally-invasive treatment, which typically involves a day case outpatient hospital procedure under local anaesthetic. It takes approximately 1 hour and is not usually painful.
What does PVE involve?
PVE is a minimally invasive technique usually carried out under local anaesthetic (although mild sedation may also be used if required). The procedure usually takes around 1 hour and involves a catheter being inserted into the affected pelvic vein(s), usually via the groin or neck.
An X-ray is used to help guide the catheter to the area that needs to be treated. Once there, the faulty veins are blocked (embolised) using a combination of tiny metal coils and foam sclerotherapy. This seals off the vein and causes it to shrink, hopefully resolving any pain or symptoms.
A detailed description of the PVE procedure
Pre-procedure
PVE is a minimally invasive outpatient procedure that will need to be carried out at a local hospital in an interventional radiology suite, usually within the x-ray (radiology) department.
You will be positioned on a radiographic table with an x-ray machine and television-like monitor (which is suspended over the table) around you. This x-ray equipment, known as a fluoroscopy machine, allows the x-ray images that are taken to be converted into video images so your consultant can watch and guide the progress of the procedure.
Once you are lying on the table, a nurse may connect you to monitors that track your heart rate, blood pressure, oxygen level, and pulse.
If you are having sedation, a nurse will insert an intravenous (IV) line into a vein in your hand or arm to administer the sedative. This will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.
The nurse will sterilize the area of your body where the catheter is to be inserted, usually via your neck or groin. They will sterilize and cover this area with a surgical drape.
Your consultant will then administer a local anaesthetic to numb the area.
Procedure
During the PVE procedure, your consultant will insert a catheter (a long thin plastic tube, usually around 2 mm in diameter) into a large vein, either in your groin or neck. This is done by a small nick in the skin. You may feel a slight pin prick when the local anaesthetic is injected and you may feel slight pressure when the catheter is inserted, but you shouldn’t feel any serious discomfort or pain.
A nurse will monitor your heart rate and blood pressure during the procedure.
Your consultant will then guide the catheter into each of the pelvic veins in turn under x-ray guidance. Each vein within the pelvis is examined by injecting a high contrast dye to assess the flow. As the contrast is injected into the veins and passes through your body, you may experience a warm, flushing feeling. This is normal.
If the veins are flowing back towards the heart, they are normal and left alone. If a vein is refluxing (causing blood to flow back down towards the legs) and causing varicose veins within the pelvis or the legs, then they are blocked (embolised) using a combination of tiny metal coils and foam sclerosant. These coils are non-magnetic, so you won’t set off any metal detectors! You may experience a warm feeling during this part.
Additional venograms are then taken to ensure the embolic agent is correctly positioned and that the reflux is no longer present.
At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.
The length of the procedure is variable depending on the complexity of your PVCS and how many veins are affected. Typically it can take between 30 and 90 minutes. In a small number of patients, a repeat procedure may be needed to block all the culprit veins. However this is very rare and most patients only require one embolisation procedure.
Post-procedure
Some patients experience mild pain or discomfort following the procedure which can be controlled by simple pain relief medications, given by the mouth or through your IV whilst you are still at the hospital.
Following the procedure, bed rest is required for a short time and most people leave the hospital within 2 to 4 hours of the procedure. The doctor or nurse will remove your IV line before you go home. If you experience considerable pain, you may have to stay in hospital longer.
You will need someone else to take you home after the procedure, particularly if you have had sedation.
Once discharged, you are able to resume your normal activities within a few days. Driving should be avoided for one week, or longer if groin discomfort should persist (which is very rare). You will also need to refrain from strenuous exercise and heavy lifting for approximately one week.
Recovery
By stopping the blood refluxing (flowing the wrong way), the pelvic varicose veins should gradually shrink away over the next few weeks. If you have any vulval varicose veins, these should also gradually shrink.
Once your pelvic veins have been embolised, if you also have any varicose veins in your legs, these can now be treated with a reduced chance of them coming back in the future.
Any symptoms that you have been having related to the varicose veins in the pelvis should improve over the next 4 to 8 weeks.
Treatment risks
PVE is a safe, successful procedure that has been used for over 20 years.
There are a few risks that include:
- Technical failure (very rare)
- Mild to moderate pelvic discomfort for the first few days post treatment. This is fairly common and best treated at home with over the counter pain relief medications
- Failure of the treatment to improve the symptoms or veins (in approximately 15% of cases)
- Recurrence of the varicose veins can occur in up to 10% of cases
- There is a very slight risk of an allergic reaction to the high contrast dye used for the x-ray or to the sclerosant used
- There is a very small risk of infection after embolisation
- Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel (called ovarian vein thrombophlebitis), bruising or bleeding at the puncture site
- There is a small chance that the embolic agent can be put in the wrong place, or that it can move over time and deprive normal tissue of its oxygen supply (this is called non-target embolisation and occurs very rarely)
- Radiation exposure to the ovaries. However, there has been no evidence that fertility or periods are affected by the procedure
A full list of potential treatment risks and side effects can be found on our treatment FAQs page.
Follow up
Your consultant may recommend a follow-up scan and visit after your procedure or treatment is complete. This is to check whether the procedure has been a success, and also allows you to discuss any changes or side-effects you have experienced from the treatment.
It may take between one to three months after PVE before it is clear whether symptoms have been controlled or eliminated.
The visible varicose veins may require local treatment, similar to other varicose veins in the legs.
Frequently asked questions
Can pelvic varicose veins be treated with endovenous laser ablation (EVLA)?
What risks are associated with PVE?
You can find the answers to these questions and more on our treatment FAQs page.
If you have any other questions, please do not hesitate to contact us, and a member of our clinic team will be pleased to help.
