Embolization of Incompetent Ovarian Vein in Women presenting with lower limb varicosities A.A.Elmghrbee, K.Bilal, P.Whitear, A.E.P.Cameron, Abu Own, Suffolk Vascular Unit Ipswich Hospital NHS Trust Isam Osman,King Saud Medical City ,Riyadh

Pacific Venous Forum 1999 Venous disease the unconquered frontier of vascular surgery ?

Introduction and Aim of the study Although pelvic vein incompetence (PVI) is well described in association with lower limb varicosities, it is often overlooked. Failure to correctly treat PVI can lead to recurrent VV disease. The aim is to evaluate the clinical outcome of ovarian vein embolization (OVE) on symptomatic ovarian vein reflux (OVR) and lower limb varicosities.

Materials and Methods 27 Patients (mean age 43.7 years, range 24-67) presenting to the vascular clinic with lower limb varicose veins and symptoms and signs suggestive of Pelvic Congestion Syndrome (PCS) (2003 to 2006) were identified from a prospectively compiled database. Underwent Pelvic venography +/- OVE . Database and notes analysed retrospectively Phone call questionnaire

Results Age No. of cases % 20-29 3 11 30-39 10 37 40-49 7 26 50-59 2 7.5 60-69 5 18.5 70-79 Total 27 100

Presentation Primary varicose veins 15 cases (55%) Recurrent varicose veins 12 cases (45%) All of them have symptoms / signs of pelvic congestion syndrome.

investigation Duplex scan 24 cases had the scan 7 cases had SFJ/SPJ reflux (3 cases recurrent) 17 cases varicosities extends up to perineum/pelvis Pelvic venogram all cases 21 cases had OVR 6 cases had no OVR

Embolization Coil embolization through femoral vein approach was carried out in 21 patients (all patients with OVR) It was radiologically successful in all pts. (100%). day case procedure, except one pt. who developed vaso-vagal attack.

Follow-up Median follow up 25 months, mean 28, range from 12 to 56 months. Follow up conducted using phone call questionnaire.

OVR AND EMBOLIZATION QUESTIONAIRE

Outcome with regard to PCS symptoms 18 reported significant improvement in pelvic symptoms 2 had no improvement in symptoms 1 had temporary improvement in pelvic symptoms and varicosities for 6 months

Outcome with regard to varicosities 6 had stab avulsions (2 recurrent, 4 1ry) 7 high ties ( 3 recurrent, 4 1ry ) 2 SPJ disconnection ( both 1ry) 6 improved surgery not needed (3 1ry ,3 recurrent)

Conclusion Radiological embolization of OVR in women presenting with PCS associated with lower limb varicosities is safe and offers medium term symptomatic improvement Longer follow up is required to assess long term benefits.