Pelvic Venous Insufficiency (PVI) is a disease that occurs when female patients have poorly functioning valves inside their ovarian veins. These typically develop in women between the ages of 25 and 45, who have had multiple children and are pre-menopause. Instead of their ovarian veins bringing blood up and out of the pelvis, the faulty valves leak, causing blood to be pulled by gravity in the wrong direction. This causes swelling in the pelvic veins located in the vulva, perineum, buttocks and upper part of the thighs, which creates a type of varicose veins in the pelvic region. It is estimated that 10% of all women develop this type of varicose vein.

What are the typical symptoms of Pelvic Venous Insufficiency?
Patients suffering from PVI usually experience severe discomfort. Symptoms can include: a feeling of chronic pelvic heaviness, tenderness and pain in the pelvis, lower-back pain, discomfort sitting or standing for long periods of time, frequent urination, and appearance of new varicose veins. Additional symptoms may include heavy menstrual bleeding, painful ovaries, and pain during or following intercourse.

How is a patient diagnosed with PVI?
Talk with your primary care physician or gynecologist about your pelvic discomfort and whether your ongoing pain might be PVI. If your referring doctor thinks this may be a possibility, he or she can refer you to an interventional radiologist at Vascular & Interventional Physicians. Our IRs are able to use diagnostic imaging to identify the root cause of diseases by utilizing MRIs, CTs, and Ultrasounds. Often, transabdominal and transvaginal ultrasounds are recommended for measuring ovarian vein sizes and reflux in order to diagnose and treat PVI. 

Why is it difficult to diagnose PVI?
Patients with the symptoms outlined above can be challenging to treat and are often diagnosed with having Chronic Pelvic Pain (CPP), which is comprised of many different conditions. Physicians who diagnose women with CPP have often undergone extensive testing with no apparent underlying cause being discovered. If you feel you are experiencing Chronic Pelvic Pain, talk with your primary care provider or gynecologist about whether you might actually have Pelvic Venous Insufficiency. A visit to VIP could uncover the underlying problem and prevent unnecessary surgery.

What is a way to treat PVI that is minimally-invasive?
At VIP, we have treated multiple patients suffering from PVI with a Pelvic Vein or Ovarian Vein Embolization (PVE/OVE). An embolization is a minimally invasive procedure that blocks the blood supply to the faulty veins, causing them to shrink. Most procedures are performed in the angiography suite under mild to moderate sedation and local anesthesia. The interventional radiologist inserts a thin tube through the vein at the top of the thigh and uses X-Ray (fluoroscopy) to guide it to the target vein. X-Ray dye is injected into the veins to identify the catheter position. Once this is confirmed, tiny coils and/or medications are injected into the blood vessels, which block the flow to the leaky veins and causes them to shrink. As a secondary benefit, atypical varicose veins that appear due to PVI usually disappear post-surgery. 

The procedure usually takes between 60-90 minutes and is typically an outpatient procedure. Afterwards, patients are monitored for several hours to ensure a comfortable recovery. Pelvic Vein Embolizations allow the patient to recover quickly and to return to a normal work routine within a week.

Preparing for Pelvic Vein Embolization:

• A representative will call you prior to your procedure to review instructions and complete registration.
• If not already performed, you may be asked to complete a transvaginal ultrasound scan prior to your procedure to determine the pelvic anatomy, specifically looking at the vascular supply.
• You will need to arrange for a driver to take you home.
• Make sure to let your doctor know if you are taking blood thinners (Aspirin, Lovenox, Plavix, Heparin, or Coumadin). You may be asked to stop taking these medications prior to your procedure.

PRE-OP:

• Do not eat or drink anything for 12 hours prior to your procedure.

INTRA-OP:

• The procedure itself is not painful; however, light sedation medications will be administered through an IV in order to prevent any discomfort.
• A small catheter is placed into the vein in the leg and advanced into the pelvic and ovarian veins under X-Ray guidance. An angiogram (injection of contrast dye) into the veins is performed to provide a road map of the blood supply to the pelvis. 
• It is possible that both ovarian and/or other pelvic veins are embolized during the procedure, in order to ensure that the entire blood supply to the faulty veins is blocked.

POST-OP:

• After the procedure, you may experience mild pain or cramping in the pelvic area, nausea, or low grade fever.
• You may begin to eat a regular diet once you are able to tolerate food.
• Patients are typically discharged after a few hours, and a follow up appointment is scheduled at that time.
• You may resume your normal activities after 48 hours and return to work within 1 week. 

If you develop fever or severe pain contact our office at 352-333-7847 (7VIP) or call your referring physician. After hours or on weekends, go to the nearest emergency room or call North Florida Regional Medical Center at 352-333-4000 and ask for the Interventional Radiologist on call.

Frequently Asked Questions

Q. Is the PVE procedure painful?
A. Not usually. You may experience pelvic pain or back pain following the procedure; however, this is usually temporary. These pains can occur in response to the intentional blockage of the veins, and they typically last a few days, gradually decreasing in severity each day. By the second or third day after the procedure, most women feel back to normal.

Q. How soon can I resume my normal activity?
A. Only light, at-home activity is recommended for 2-3 days post-procedure for short (not prolonged) periods of time. It is also recommended that you take a few days (2-3) off from work. You may return to unrestricted activity, including sexual activity and exercise, 7 days after the procedure. Travel plans should be limited to short distances for the first two weeks.

Q. Will I have to observe a special diet?
A. You may resume your usual diet and medications immediately. Drinking plenty of liquids may also be helpful as well to prevent any constipation that may occur with strong pain medicines.

Q. What kind of medication will I need to take?
A. You will be given a prescription for medication to take over the next 7-10 days to help manage any pain and inflammation that may occur. It is recommended that you take anti-inflammatory medicine for the first 3-5 days following the procedure. If this medicine is not helpful, you may take whatever kind of anti-inflammatory medicine that works best for you. (Ibuprofen, Motrin, Naprosyn, etc.). A stronger pain medication may be prescribed, which can be taken on an as needed basis. A medication for nausea can also be prescribed to be taken as needed. If these medications do not seem to be working, please call and we can prescribe you an alternative.

Q. What do I need to know about the puncture site? 
A. The catheter site is covered with a small dressing and can be removed after 24 hours. You may shower and gently wash this area, and then apply a band-aid for one more day. After this, you may leave the area uncovered. It is not unusual to notice some discoloration or bruising in this area. If you notice marked swelling or active bleeding, apply direct pressure with your fingers and either call for assistance or go to the nearest emergency room for evaluation. This is very uncommon. A small “knot” may develop under the skin, which typically resolves in 2-3 weeks. This is part of the normal healing process. Persistent pain at the puncture site is also uncommon, but may be due to irritation of the nerve that lies next to the blood vessels. This is also treated with anti-inflammatory medicine and usually resolves on its own.

Q. What do I do if I have a fever?
A. You may experience a mildly elevated temperature in the few days following the procedure. This can occur in 10-15% of cases, but does not necessarily indicate infection. Motrin or Tylenol may be helpful in relieving this. Persistent, high fever (greater than 101.5) lasting more than 3 days MAY indicate infection, in which case you should call the Vascular & Interventional Physicians’ (VIP) office (352-333-7847) immediately.

Q. Will I need a check-up?
A. The VIP office staff will call you the day after your discharge to check on your progress and answer any questions. At that time, a 2-3 week follow-up appointment will be scheduled to check the small incision site and arrange your 3 month follow-up visit. If of interest, this check-up visit can also be conducted virtually via telemedicine. In addition, you should maintain your regular gynecologic care with your gynecologist.