Skip to main content


Log in

Pelvic Vein Embolisation in the Management of Varicose Veins

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript


Pelvic vein incompetence is common in patients with atypical varicose veins, contributing to their recurrence after surgery. Therefore, refluxing pelvic veins should be identified and treated. We present our experience with pelvic vein embolisation in patients presenting with varicose veins. Patients presenting with varicose veins with a duplex-proven contribution from perivulval veins undergo transvaginal duplex sonography (TVUS) to identify refluxing pelvic veins. Those with positive scans undergo embolisation before surgical treatment of their lower limb varicose veins. A total of 218 women (mean age of 46.3 years) were treated. Parity was documented in the first 60 patients, of whom 47 (78.3%) were multiparous, 11 (18.3%) had had one previous pregnancy, and 2 (3.3%) were nulliparous. The left ovarian vein was embolised in 78%, the right internal iliac in 64.7%, the left internal iliac in 56.4%, and the right ovarian vein in 42.2% of patients. At follow-up TVUS, mild reflux only was seen in 16, marked persistent reflux in 6, and new reflux in 3 patients. These 9 women underwent successful repeat embolisation. Two patients experienced pulmonary embolisation of the coils, of whom 1 was asymptomatic and 1 was successfully retrieved; 1 patient had a misplaced coil protruding into the common femoral vein; and 1 patient had perineal thrombophlebitis. The results of our study showed that pelvic venous embolisation by way of a transjugular approach is a safe and effective technique in the treatment of pelvic vein reflux.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Perrin MR, Guex JJ, Ruckley CV et al (2000) Recurrent varices after surgery (REVAS): a consensus document. Cardiovasc Surg 8:233–245

    Article  PubMed  CAS  Google Scholar 

  2. Jones L, Braithwaite BD, Selwyn D et al (1996) Neovascularization is the principal cause of varicose vein recurrence: results of a randomized trial of stripping the long saphenous vein. Eur J Endovasc Surg 12:442–445

    Article  CAS  Google Scholar 

  3. Fischer R, Linde N, Duff C et al (2001) Late recurrent sapheno femoral junction reflux after ligation and stripping the greater saphenous vein. J Vasc Surg 34:236–240

    Article  PubMed  CAS  Google Scholar 

  4. Hobbs JT (2005) Varicose veins arising from the pelvis due to ovarian vein incompetence. Int J Clin Pract 59:1195–1203

    Article  PubMed  CAS  Google Scholar 

  5. Labropoulos N, Touloupakis E, Giannoukas AD et al (1996) Recurrent varicose veins: investigation of the pattern and extent of reflux with color flow duplex scanning. Surgery 119:406–409

    Article  PubMed  CAS  Google Scholar 

  6. Perrin MR, Labropoulos N, Leon LR Jr (2006) Presentation of the patient with recurrent varices after surgery (REVAS). J Vasc Surg 43(2):327–334

    Article  PubMed  Google Scholar 

  7. Dodd H, Wright AP (1959) Vulval varicose veins in pregnancy. Br Med J 1:831–832

    Article  PubMed  CAS  Google Scholar 

  8. Dixon JA, Mitchell WA (1970) Venographic and surgical observations in vulvar varicose veins. J Surg Gynaecol Obstet 131:458–464

    CAS  Google Scholar 

  9. Hodgkinson CP (1953) Physiology of the ovarian veins during pregnancy. Obstet Gynecol 1:26–37

    PubMed  CAS  Google Scholar 

  10. Park SJ, Lim JW, Ko YT et al (2004) Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. Am J Roentgenol 182:683–688

    Google Scholar 

  11. Beard RW, Highman JH, Peare S et al (1984) Diagnosis of pelvic varicosities in women with chronic pelvic pain. Lancet 2:946–949

    Article  PubMed  CAS  Google Scholar 

  12. Creton D, Hennequin L, Kohler F et al (2007) Embolisation of symptomatic pelvic veins in women presenting with nonsaphenous varicose veins of pelvic origin―three-year follow-up. Eur J Vasc Endovasc Surg 34:112–117

    Article  PubMed  CAS  Google Scholar 

  13. Monedero JL, Ezpeleta SZ, Castro JC et al (2006) Embolization treatment of recurrent varices of pelvic origin. Phlebology 21:3–11

    Article  Google Scholar 

  14. Cordts PR, Eclavea A, Buckley PJ et al (1998) Pelvic congestion syndrome: early clinical results after transcatheter ovarian vein embolization. J Vasc Surg 28:862–868

    Article  PubMed  CAS  Google Scholar 

  15. Geier B, Mumme A, von Rothenburg T et al (2006) Reflux patterns in patients with pelvic venous insufficiency and varicose veins. Society for Clinical Vascular Surgery, March 8–11, 2006, Las Vegas, NV, USA (Presented on March 9, 2006)

  16. Kennedy A, Hemingway A (1990) Radiology of ovarian varices. Br J Hosp Med 44:38–42

    PubMed  CAS  Google Scholar 

  17. Richardson GD, Beck TC, Mykytowycz M et al (1999) Pelvic congestion syndrome: diagnosis and treatment. Aust N Z J Phlebology 3:51–56

    Google Scholar 

  18. Capasso P, Simons C, Trotteur G et al (1997) Treatment of symptomatic pelvic varices by ovarian vein embolization. Cardiovasc Int Radiat 20:107–111

    Article  CAS  Google Scholar 

  19. Richardson GD, Beckwith TC, Sheldon M (1991) Ultrasound windows for abdominal and pelvic veins. Phlebology 6:111–125

    Google Scholar 

  20. Coakley FV, Varghese SL, Hricak H (1999) CT and MRI of pelvic varices in women. J Comp Assist Tomogr 23:429–434

    Article  CAS  Google Scholar 

  21. Gupta A, McCarthy S (1994) Pelvic varices as a cause for pelvic pain: MRI appearance. Magn Reson Imaging 12:679–681

    Article  PubMed  CAS  Google Scholar 

  22. Mathis BV, Miller JS, Lukens ML et al (1995) Pelvic congestion syndrome: a new approach to an unusual problem. Am Surg 61:1016–1018

    PubMed  CAS  Google Scholar 

  23. Russ PD, Gullo G (2000) Pelvic varices diagnosed with endorectal surface coil magnetic resonance imaging: case report. Can Assoc Radiat J 51:23–27

    Google Scholar 

  24. Lechter A, Alvarez A (1985) Pelvic varices and gonadal veins. In: Negus D, Jantet G (eds) Phlebology 85. Libbey, London, UK, pp 225–228

    Google Scholar 

  25. Richardson GD, Driver B (2006) Ovarian vein ablation: coils or surgery? Phlebology 21:16–23

    Article  Google Scholar 

  26. Edwards RD, Robertson IR, MacLean AB et al (1993) Pelvic pain syndrome: successful treatment of a case by ovarian vein embolisation. Clin Radiat 47:429–431

    Article  CAS  Google Scholar 

  27. Venbrux AC, Chang AH, Kim HS et al (2002) Pelvic congestion syndrome (pelvic venous incompetence): impact of ovarian and internal iliac vein embolotherapy on menstrual cycle and chronic pelvic pain. J Vasc Interv Radiol 13:171–178

    Article  PubMed  Google Scholar 

  28. Maleux G, Stockx L, Wilms G et al (2000) Ovarian vein embolization for the treatment of pelvic congestion syndrome: long-term technical and clinical results. J Vasc Interv Radiol 11:859–864

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Anthony Lopez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ratnam, L.A., Marsh, P., Holdstock, J.M. et al. Pelvic Vein Embolisation in the Management of Varicose Veins. Cardiovasc Intervent Radiol 31, 1159–1164 (2008).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: