1. 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

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

3. 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.

4. 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

5. 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

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

7. 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

9. 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.

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

12. OVR AND EMBOLIZATION QUESTIONAIRE

13. 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

14. 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)

15. 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.