Ovarian Vein Embolization: How and When Should It Be Done?

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Gynecology

Background:

• Pelvic Venous Disease (PeVD) is defined by pelvic varicosities and chronic pelvic pain, often exacerbated by upright posture.
• It disproportionately affects multiparous and premenopausal women, commonly stemming from pelvic venous insufficiency (PVI) due to incompetent valves.
• Diagnosis involves noninvasive imaging (ultrasound, CT, MRI) and invasive venography to characterize venous abnormalities.

Purpose of the Study:

• To provide an overview of patient selection, interventional techniques, challenges, and outcomes for ovarian vein embolization in treating PeVD.
• To highlight the efficacy of embolization as a standard management option for PeVD.
• To emphasize the importance of diagnostic work-up and patient selection for successful outcomes.

Main Methods:

• Review of diagnostic modalities including ultrasound, CT, MRI, and venography for characterizing PeVD.
• Discussion of ovarian and/or internal iliac vein embolization as an interventional treatment.
• Analysis of factors influencing therapeutic success, such as patient parity and presenting symptoms.

Main Results:

• Ovarian and/or internal iliac vein embolization demonstrates excellent technical and clinical success rates for PeVD.
• Complication rates associated with embolization are relatively low.
• Multiparous women show higher success rates post-embolization compared to those with dyspareunia.

Conclusions:

• Embolization of ovarian and/or internal iliac veins is a standard management option for PeVD, alongside medical therapy.
• Careful patient selection and diagnostic work-up are crucial for achieving optimal therapeutic success.
• Further research is needed to identify additional predictors for successful outcomes after embolization therapy.