Comparison Of Results Of Coil And Surgical Treatment Of Ovarian Reflux

Patients treated by surgery from 1989 until 1998, and endovascular treatment from 1999 until June 2002 were studied using a questionnaire with visual analog scales. Statistical analysis of pelvic heaviness and overall satisfaction showed no difference between endovascular and surgical treatment.25 Both treatments resulted in statistically significant improvement after treatment. A decision to treat in both groups was based on clinical findings and ultrasound assessment, and there was no statistical difference in the presenting features of patients in either the surgical or the endovascular series.

Patients undergoing coil treatment were also subjected to follow-up ultrasound studies at six weeks-six months and also abdominal radiographs. There was no evidence of coil migration in 34 patients. Early ultrasounds showed two clots in broad ligament veins, no significant reduction in diameter at six to 10 weeks, but some evidence of reduction by six months.

Long-term results of endovascular treatment have not yet been reported. Re-canalization remains possible but should be amenable to further endovascular treatment. Although the great majority of patients tolerate coil treatment with little discomfort, anxious patients are more difficult to cannulate the femoral vein, and spasm of the ovarian vein could lead to perforation. Patients have far less loin discomfort than after surgery, but it seems excessive exercise should be restricted. A few patients have severe pain and this could be due to thrombosis of the ovarian vein or perforation.

Patient satisfaction justifies ablation of an ovarian vein shown by ultrasound to reflux.

Provided endovascular ovarian vein ablation can be delivered safely and at reasonable cost, then there are definite advantages over surgical treatment. Complications can occur from either method. The incidence of long-term recan-alization is unknown.

There is no evidence that endovascular treatment produces better results than surgery. Provided patients are prepared to accept the scar, pain, hospitalization, and other potential complications of an operation, at this point one cannot say surgical treatment has been superseded.


1. Taylor HC, Wright H. Vascular congestion and hyperaemia, Am J Obst

Gynecol. 1949. 57: 211-230.

2. Hobbs JT. The pelvic congestion syndrome, Br J Hosp Med. March 1990. 43: 200-206.

3. Dodd H, Wright AP. Vulval varicose veins in pregnancy, Br Med J. 1959. 1: 831-832.

4. Dixon JA, Mitchell WA. Venographic and surgical observations in vulvar varicose veins, J Surg Gynaecol Obstet. 1970. 131: 458-464.

5. Craig O, Hobbs JT. Vulval phlebography in the pelvic congestion syndrome, Clin Radiol. 1974. 24: 517-525.

6. Heiner G, Siegel T. Zur Frage des Iokalen Kontrast Mittel Schadigung bei der Uterus Phlebography, Z Cl Gynak. 1925. 87: 829.

7. Chidakel N, Ediundh KO. Transuterine phlebography with particular reference to pelvic varicosities, Acta Radiol. 1968. 7: 1-12.

8. Lea Thomas M, Hobbs JT. Vulval phlebography in the pelvic congestion syndrome, Clin Radiol. 1974. 25: 517.

9. Ahlberg NE, Bartley O, Chidakel N. Retrograde contrast filling of the left gonadal vein, Acta Radiol. 1965. 3: 385.

10. Chidakel N. Female pelvic veins demonstrated by selective renal phle-bography with particular reference to pelvic varicosities, Acta Radiol. 1968. 7: 193-209.

11. Gupta A, McCarthy S. Pelvic varices as a cause of pelvic pain: MRI appearance, Magn Reson Imaging. 1994. 12(4): 679-681.

12. Richardson GD, Beckwith TC, Sheldon M. Ultrasound windows to abdominal and pelvic veins, Phlebology. 1991. 6: 111-125.

13. Richardson GD, Beckwith TC, Sheldon M. Ultrasound assessment in the treatment of pelvic varicose veins. Presented to The American Venous Forum 1991. Fort Lauderdale.

14. Farquhar CM, Rogers V, Franks S, Pearce S, Wadsworth J, Beard RW. A randomized controlled trail of medroxyprogesterone acetate and pschycotherapy for the treatment of pelvic congestion, Br J Obstet Gynaecol. 1989. 96: 1153-1162.

15. Reginald PW, Beard RW, Kooner JS et al. Intravenous dihydroergota-mine to relieve pelvic congestion with pain in young women, Lancet. August 1987: 351-353.

16. Beard RW, Kennedy RG, Gangar KE et al. Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associated with pelvic congestion, Br J Obstet Gynaecol. 1991. 98: 988-992.

17. Lechter A. Pelvic varices: Treatment, J Cardiovasc Surg. 1985. 26: 111.

18. Gomez ER, Villavicencio JL, Conaway CW, Collins PS, Orecclina PM, Salander JM, Rich NM. The management of pelvic varices by combined retroperitoneal ligation and sclerotherapy (Abstract), European American Venous Symposium. 1987. Washington DC.

19. Richardson GD, Beckwith TC, Mykytowycz M, Lennox AF. Pelvic congestion syndrome—Diagnosis and treatment, ANZ J Phlebol. Nov 1999. 3(2): 51-56.

20. Scott J, Huskisson EC. Graphic representation of pain, Pain. 1976. 2: 175-184.

21. Edwards RD, Robertson IR, McLean AB, Hemingway AP. Case report: Pelvic pain syndrome—Successful treatment of a case by ovarian vein embolization, Clin Radiol. 1993. 47: 429-431.

22. Sichlau MJ, Yao JST, Vagelzang RL. Transcatheter embolotherapy for the treatment of pelvic congestion syndrome, Obstet Gynecol. 1994. 83: 892-896.

23. Boomsma J, Potocky V, Kievit C, Vertrulsdonek J, Gooskens V, Weemhof R. Phlebography and embolization in women with pelvic vein insufficiency, Medica Mundi. 1998. 42(2): 22-29.

24. Cordts P, Eclavea A, Buckley P, DeMaioribus C, Cockerill M, Yeager T. Pelvic congestion syndrome: Early clinical results after transcatheter ovarian vein embolisation, Vasc Surg. 1998. 5: 862-868.

25. Richardson GD, Driver B, Ovarian vein ablation: Coils or surgery? Phlebology. 2006. 21: 16-23.

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