GONADAL VEIN EMBOLIZATION
GVE is a procedure for the treatment of chronic pelvic congestion syndrome.
The condition causes chronic pelvic pain in women. Often under-diagnosed, many women have been told the problem is “all in their head.”
However, recent studies conclusively indicate this pelvic pain may be due to varicose veins in the pelvis. This condition is known as pelvic congestion syndrome.
Chronic pelvic pain can be debilitating. Some 15% of all gynecology visits are attributed to chronic pelvic pain.
We work closely with your doctor to determine whether your symptoms are related to chronic pelvic congestion and if so, that gonadal vein embolization is an appropriate therapy for you.
What is chronic pelvic congestion?
Similar to varicose veins in the legs, valves in the veins in the pelvis become weakened, allowing blood to pool in the vein and cause pressure and pain. The causes of chronic pelvic pain are varied, but are often associated with the presence of gonadal and pelvic varicose veins. Pelvic congestion syndrome is similar to varicose veins in the legs.
In both cases, the valves in the veins that help return blood to the heart against gravity become weakened and don’t close properly. This allows blood to flow backwards and pool in the vein, causing pressure and bulging veins. In the pelvis, varicose veins can cause pain and affect the uterus, ovaries and vulva.
What are the symptoms of pelvic congestion?
The chronic pain that is associated with this disease is usually dull and aching. Women experience a dragging sensation or pain in the pelvis. Symptoms include:
- Deep pelvic pain when sitting or standing
- Pain that worsens throughout the day
- Bulging veins on the vulva, buttocks and/or the thighs
- Painful menstrual cycles
- Pain during or after intercourse
- Lower abdominal and back pain
- During and after pregnancy
The varicose veins in the pelvis surround the ovaries and can also push on the bladder and rectum. Other symptoms include:
- Irritable bladder
- Abnormal menstrual bleeding
- Vaginal discharge
- Varicose veins on the the labia, buttocks and thigh are a definite sign of pelvic venous congestion.
What are the risk factors for chronic pelvic congestion?
Risk factors include:
- Two or more pregnancies and hormonal increases
- Fullness of leg veins
- Polycystic ovaries Hormonal dysfunction
Why is the diagnosis of varicose veins of the pelvis so often missed?
Pressure from bulging gonadal veins while standing is generally relieved when lying horizontally for a pelvic exam. If you bear down, any enlarged veins may appear.
If your provider is ordering a test to help determine whether you have chronic venous congestion, RIA Endovascular finds that ordering a pelvic ultrasound with valsalva (bearing down) is helpful, as the enlarged veins may become apparent. However, a CT Venogram of the abdomen and pelvis provides a definitive diagnosis and is therefore preferred. If you already have a pelvic ultrasound with valsalva, we can take it from there.
How is pelvic congestion diagnosed?
Other treatable conditions such as inflammation, disease and other conditions should be ruled out by your gynecologist by a thorough pelvic exam. We will work closely with your physician, who can refer you. You can also refer yourself; however, we will want you to work with your physician to coordinate care.
Pelvic congestion syndrome can be diagnosed by an endovascular specialist using various imaging techniques such as pelvic venography, MRI, pelvic ultrasound or transvaginal ultrasound. If your doctor is ordering a pelvic ultrasound, RIA Endovascular recommends ordering the ultrasound with valsalva (bearing down) so the troublesome veins become more apparent.
What are the treatment options for chronic pelvic congestion?
Early treatment options include medications or suppression of ovarian function through birth control.
Another option is open or laparoscopic surgery to tie the troublesome veins. These procedures are both more invasive than gonadal vein embolization, require general anesthesia, and have a longer recovery period.
Gonadal vein embolization offers a safe, effective, minimally invasive treatment option that is less expensive to surgery and less invasive. It is an outpatient hospital procedure which requires only conscious sedation. Once the procedure is performed, you can return home a few hours later the same day.
Does insurance cover gonadal vein embolization?
Insurance generally covers this procedure, and we accept most insurance plans. Our in-office preauthorization specialist will obtain pre-certification from your insurance company for your upcoming procedure.
How do I prepare for gonadal vein embolization (GVE)?
After your consultation − if you are an appropriate candidate − our pre-certification specialist will work with your insurance provider to preauthorize the procedure. We will provide you with written pre-procedure instructions. In your patient registration papers, we will want to know about:
- Recent illnesses
- Medical conditions
- Any possibility that you are pregnant. The pelvic venography and pelvic vein embolization procedures require X-rays which would expose the fetus to radiation.
- Medications you take, including prescribed, herbal and over-the-counter medications. If you are taking blood-thinners, you will receive special instructions before the procedure about what to do.
- Allergies you have. If you have a known allergy to iodine or contrast dye, please let us know, because contrast dye is used in the procedure to visualize the veins being treated.
Wear comfortable clothing. On the day of the scheduled procedure, arrive at the hospital as directed for your outpatient procedure. You will be given a gown to wear during the procedure. You will be asked to sign a consent form, During the procedure, you will have conscious sedation, so be sure to have a driver to take you home.
What is the gonadal vein embolization procedure?
Gonadal vein embolization is a minimally invasive, outpatient hospital treatment for pelvic congestion syndrome. The goal is to close off faulty veins so they can no longer enlarge with blood, thus relieving the pain. After injecting a sedative to make you sleepy, a local anesthetic is given to numb the skin at the groin. Next, a small nick in the skin (less than a 1/4 inch long) will be made so that a very thin tube, called a catheter, can be inserted into the femoral vein. Using image guidance, the catheter is directed through the femoral vein to the faulty vein(s). When in place, the catheter delivers tiny coils, often with a sclerosing agent. (A Sotradecol foam agent, the same type of material used to treat varicose veins in the legs, is often used.) The coils, combined with the sclerosant, allows the radiologist to block and seal even the smallest veins. In most cases, it is the gonadal vein that is the problem. However, other pelvic veins (such as the internal iliac vein, internal pudendal vein, obturator vein and ischial vein) may be the source of the problem, and will require treatment.
What can I expect after the procedure?
Plan to be in the recovery room for a few hours, after which you will be released. Patients typically experience pelvic cramps for several days after gonadal vein embolization. The cramps are most severe during the first 24 hours after the procedure, and improve rapidly over the next several days. Oral pain medication is provided upon discharge. Most women recover within one to two weeks after gonadal vein embolization, and are able to return to their normal activities. Most experience a reduction in pelvic pain in two to three weeks.
How successful is the gonadal vein embolization procedure?
Medical literature shows that the procedure provides complete or partial relief in approximately 90% – 95% of the cases. In addition to being less expensive to surgery and much less invasive, embolization offers a safe, effective, minimally invasive treatment option that restores patients to normal.