Ovarian Vein Embolization: How and When Should It Be Done?

Techniques for Embolization of the Ovarian Vein and Pelvic Reservoir

Pelvic venous disorders are a common and under diagnosed cause of chronic pelvic pain in women, presenting with chronic, noncyclical pelvic pain for greater than 6 months and the presence of pelvic varicosities. Pelvic varices and ovarian vein reflux are a strong indicator of venous origin chronic pelvic and may benefit from embolization. This most commonly occurs in multiparous, premenopausal women with symptoms of gravity dependent pelvic pain and postcoital pain. Additional causes of pelvic venous disorders include iliac vein compression, internal iliac vein reflux, and renal vein compression, however for the purposes of this article we will focus on ovarian vein insufficiency. The mainstay of treatment for pelvic venous insufficiency is Ovarian Vein Embolization and embolization of the pelvic venous reservoir. This article will focus on the patient presentation and workup, followed by a detailed summary of how to perform this procedure, current research to support treatment, possible technical challenges and complications, and finally future research priorities.

Female Gonadal Venous Insufficiency in a Clinical Presentation Which Suggested an Acute Abdomen-A Case Report and Literature Review

Pelvic venous insufficiency (PVI) is frequently associated with symptoms of abdominal pain or discomfort that is overlooked or under-diagnosed in women. Despite the fact that pelvic venous insufficiency in men is very well documented, its occurrence in women needs to be further studied. Patients with pelvic varicose veins undergo a long and inconclusive diagnostic work-up before the exact cause of the symptoms is identified. Gonadal venous insufficiency (GVI) is a condition that can present acutely, leading to diagnostic challenges. We present a case report of a 47-year-old female with acute abdominal pain and GVI, where endovascular embolization was used for successful treatment. The patient was diagnosed with GVI based on imaging findings of an enlarged left ovarian vein with retrograde flow and dilated pelvic veins seen on magnetic resonance imaging (MRI) with contrast material. Due to the severity of her symptoms and imaging findings, endovascular embolization was chosen as the treatment modality. The embolization was successful, and the patient's symptoms resolved completely. This case highlights the challenge of diagnosing GVI with acute clinical expression and the potential benefits of endovascular embolization as a treatment option. Further studies are needed to determine the optimal management strategies for acute GVI, but endovascular embolization should be considered a safe and effective option. At the same time, we present a short review of the recent literature data related to this topic.

Anatomical Analysis of the Gonadal Veins and Spine in Lateral Lumbar Interbody Fusion

BACKGROUND

The current study aimed to investigate the anatomical position of the gonadal veins (GVs) from the viewpoint of spine surgery and the risk factors associated with lateral lumbar interbody fusion (LLIF).

METHODS

This retrospective study included 99 consecutive patients. The GV locations were divided into the ventral (V), dorsal medial (DM), and dorsal lateral (DL) sides based on lumbar disk levels on axial contrast-enhanced computed tomography images. The DM region surrounded by the vertebral body and psoas muscle had the highest risk of GV injury. The GV at each intervertebral disk level was examined in terms of laterality and sex. The patients were divided into group M (which included those with GV in the DM region at any vertebral level) and group O (which included those without GV in the DM region at any vertebral level). Then, the two groups were compared.

RESULTS

In the case of lower lumbar levels and in women, the GVs were commonly observed in the DM region. Group M had a higher incidence of degenerative scoliosis than group O and a significantly larger Cobb angle.

CONCLUSIONS

We should pay close attention to the GV location on the preoperative image when using LLIF, particularly in female patients with degenerative scoliosis.