Pelvic Congestion Embolization

Columbia Radiology's interventional radiologists have extensive experience with the diagnosis and treatment of pelvic congestion, a little-understood condition that leads to chronic pelvic pain.

Pelvic congestion is not uncommon among women and can be very difficult to diagnose. You may feel a dull, ongoing pain that may worsen around intercourse or when you have been standing or sitting for long periods of time. Because pelvic pain in women can point to many different conditions, your physician may rule out other causes before reaching a diagnosis of pelvic congestion. In addition, some physicians are unaware or fail to look for this condition.

The pain caused by this syndrome can be traced to varicose veins that develop in the pelvis and ovaries. Veins become “varicose” when their walls or valves are stretched or weakened by the pressure of blood flowing through them, and blood collects in them. Interventional radiologists use a treatment called embolization to close off these weakened veins and to re-route the blood circulation around them. 

Consult Our Interventional Radiologists About Your Pelvic Pain

For women who have been diagnosed with pelvic congestion—or when pelvic congestion is suspected—a consultation with one of our interventional radiologists can help with both diagnosis and treatment. 

Pelvic congestion is difficult to diagnose. A pelvic exam and routine imaging will not show enlarged veins, so it's important to get appropriate imaging tests, such as ultrasound, CT, or MRI. It's also important to rule out other potentially serious conditions.

The most accurate diagnosis for pelvic congestion is called a venogram and is performed by an interventional radiologist, who inserts a long, thin tube called a catheter into a vein in the neck or groin and uses X-ray imaging to guide it to the ovarian and pelvic veins.  Contrast dye is injected to make the veins more visible. If enlarged, leaky veins are discovered, we can treat them during the same procedure.

Our physicians will review treatment options and help you determine whether a venogram and embolization is the best approach for your pelvic pain. 

Treatment at Columbia Interventional Radiology

Treatment for pelvic congestion by embolization is minimally-invasive and very effective when performed by an experienced interventional radiologist.  Our patients go home on the day of their procedure and are back to normal activities within a week.

Using X-ray imaging guidance, our interventional radiologists block blood flow to the veins by closing them off with a tiny metallic coils or other blocking ("embolic") agents. Once the flow of blood through the veins is stopped, the vein shrinks and most women experience a significant reduction of their pain.

What will happen during the procedure?

On the night before the procedure eat a light meal, then do not eat or drink anything after midnight. We will provide you with more detailed information about which medications you may take in days before and on the morning of the procedure.

When you arrive at the interventional radiology suite, we will have you lie on a table then we will insert an intravenous line in your arm and give you conscious sedation to relax you and block any pain. Using image guidance (usually fluoroscopy, a kind of X-ray “movie”), we will insert a catheter (a long, thin, hollow plastic tube) through a small incision in your groin or neck and guide it to the veins that are potentially causing the pain. We will inject a contrast dye through the catheter into the veins to highlight them on the fluoroscopy image, making it possible to tell if these veins have become enlarged, or if the flow in those veins is going in the opposite direction.

If we identify any varicose veins we can treat them immediately by placing a coil and/or embolic agent in the vein to block the blood flow. After the procedure is completed we will remove the catheter. The procedure takes from 30 minutes to several hours depending on how many veins require treatment. If there are too many veins to treat during one procedure we may perform a second embolization procedure three to six weeks after the first one.

Are there any risks?

Extremely rare potential complications of embolization include (but are not limited to) allergy, perforation of a vein, a blood clot in a vein, and migration of the embolic agent from its original site.

After the procedure

Most women remain in the interventional radiology suite for several hours of rest and observation following embolization. Some degree of mild discomfort or pain may occur following pelvic vein embolization, which we control with an oral or intravenous pain medication. You should be able to resume your normal activities within a week.