Venous embolisation The Phlebology Clinic / Services / Venous treatments / Venous embolisation Introduction Key information Description of treatment Venoplasty Venous stenting Introduction Venous embolisation is a minimally invasive endovascular procedure that involves the controlled closure of an insufficient venous vessel, leading to its exclusion from the bloodstream. The name "embolisation" comes from the word "embolus", which means a material that blocks the lumen of a vessel (literally – causing an embolism). This procedure, performed by the experienced team at Klinika Flebologii in Warsaw, is usually a key element (one of the stages) of the causal treatment of venous disease. Pelvic venous insufficiency, which is often the cause of many non-specific symptoms in the lower abdomen, pelvic floor, or perineum, and the most common cause of venous insufficiency of the lower limbs (especially among women), has a slightly different character in women and men. In women, it most commonly affects the ovarian veins and branches of the internal iliac veins, leading to a symptom complex called zespołem przekrwienia biernego miednicy (ang. Pelvic Congestion Syndrome, PCS). In men, on the other hand, the most common problems are testicular vein insufficiency, volume overload of the internal iliac veins, and secondary varicocele. The most common varicoceles include those of the spermatic cord. Regardless of gender, at Klinika Flebologii in Warsaw, we always strive for comprehensive treatment of all insufficient venous trunks and the elimination of pathological venous reservoirs during a single procedure. This ensures better clinical outcomes, a lower dose of contrast agent administered, less radiation absorbed, a more favorable post-operative course (no clotting of non-embolized outflows), a significantly lower recurrence rate of venous disease, and, most importantly, the possibility of continuing treatment. A patient who has undergone partial treatment (incomplete venous embolization) cannot be subjected to treatment for varicose veins in the intimate areas or varicose veins on the legs. History of the development of embolization techniques in the treatment of pelvic venous insufficiency The history of venous embolization procedures dates back to the early 1990s. The first documented embolization of the ovarian veins in the treatment of pelvic passive congestion syndrome(as the symptomatic form of pelvic venous insufficiency was then defined) was performed by Edwards and his team in 1993 (photo adjacent). This pioneering – as it later turned out – procedure opened new possibilities for the minimally invasive treatment of venous diseases of the abdominal cavity and lesser pelvis. In the following years, embolization techniques in the venous system were gradually improved. Initially, sclerotherapy, i.e., the chemical administration of obliterating agents into the lumen of insufficient venous vessels, was mainly used. In the late 1990s, embolization coils (so-called vascular coils) were introduced into clinical practice, which significantly improved the effectiveness and safety of the procedures. Pierwszy udokumentowany przypadek wykonania embolizacji żyły jajnikowej lewej [Clinical Radiology, 1993]. A real breakthrough in embolization procedures occurred at the beginning of the 21st century with the development of imaging techniques. The introduction of modern C-arm X-ray machines popularized this excellent treatment method. The development of venous embolization techniques is a perfect example of how technological progress in medicine directly translates into the quality of patient care. Contemporary phlebology can offer patients effective, minimally invasive treatments that seemed impossible to achieve just three decades ago. At Klinika Flebologii in Warsaw, we have developed our own proprietary method of performing venous embolization over the years. In short, our strategy is based on a good treatment plan, atraumatic access to the venous vessel (most often from a percutaneous upper extremity approach), and performing the procedure using the minimum dose of contrast agent and radiation. We encourage you to read our scientific publication: link Venous embolization – a breakthrough in the treatment of venous disease. Have you heard about venous embolization or the causal treatment of venous disease? It's a true revolution in the treatment of venous disease! In this video, we explain what this innovative method involves and why it is so effective. Knowledge that can help you! What can be treated using venous embolization? Venous embolization is an effective treatment method for many phlebological conditions, including: symptomatic pelvic venous insufficiency: this is the most common indication for venous embolization in women, manifesting as chronic pelvic pain, vulvar and intimate area varicose veins, as well as urogenital complaints; symptomatic varicocele in men, associated with testicular vein insufficiency; venous malformations and venous hemangiomas in various locations, e.g., in the intimate areas or within the veins of the lower limbs; secondary changes due to venous compression phenomena, such as: the "nutcracker syndrome" or May-Thurner syndrome, which can cause blood stasis in reservoir veins. After embolization of the ovarian veins (LOV, ROV) After embolization of the left ovarian vein and collateral circulation Left testicular vein insufficiency and varicocele Advantages of venous embolization procedures performed at Phlebology Clinic minimal invasiveness and safety of the entire procedure (venous embolization is an endovascular procedure, not surgery); venous embolization is typically performed through one or two 2-3 mm percutaneous access points created under local anesthesia with ultrasound and low-dose X-ray guidance; we use local anesthesia and light sedation instead of general anesthesia (the entire procedure is monitored by an anesthesiology team); comfort during the procedure – lying on the back; short stay (from 3 to 6 hours) in the day hospital ward with medical and nursing care; quick return to daily activities after the procedure; cosmetic benefits (no scars, which occur after surgical treatment); negligible risk of complications due to the minimally invasive nature of the procedure, precision of execution, and extensive experience of the diagnostic and interventional team; high long-term effectiveness (in an assessment of over 10 years of effectiveness of venous embolization at Klinika Flebologii – being an element of the causal treatment of venous disease – it amounts to over 95%). Embolization materials used at the Phlebology Clinic At the Phlebology Clinic, we use the most modern embolization materials for venous embolization procedures, which ensure the safety and effectiveness of the treatment. These include: embolisation coils embolization coils usually consist of a core made of a precious metal (platinum). This core is surrounded by synthetic fibers, often made of dacron, which have thrombogenic properties, meaning they promote the formation of a controlled clot in the vessel being closed. The materials from which embolization coils are made are perfectly visible using X-ray fluoroscopy during the procedure. Importantly, all the latest coils used at Klinika Flebologii do not interfere with future magnetic resonance imaging (MRI) scans. Patient after embolization of the internal pudendal vein plexus. (1) varicose dilation of the plexus after contrast administration; (2) contraction of the vascular bed immediately after administration sclerosant and insertion of an embolization coil (3) internal pudendal vein plexus excluded from circulation. foamed sclerosants (known as sclerosing agents): are injected into the lumen of the venous vessel to cause its closure by inducing inflammation and fibrosis. The sclerosant in foam form (aerosol) adheres better to the wall of the venous vessel, displacing the blood from it. This significantly increases the effectiveness of the procedure. The use of foamed sclerosants is considered a much safer alternative compared to tissue adhesives, which often cause allergic reactions and chronic granulation. Foamed sclerosants are used at Klinika Flebologii in conjunction with embolization coils. The proprietary embolization treatment technique, which we have developed over the years at our Clinic, is much more effective than the globally popular "sandwich" technique (which involves the sparse placement of coils in the vessel being closed and the administration of foamed sclerosant in between). At Klinika Flebologii, we avoid the use of tissue adhesives for the embolization of venous vessels in the abdominal cavity and pelvis for the reasons mentioned above. The use of tissue adhesives also results in much higher rates of recanalization of the embolized venous vessels. Vascular Laboratory – modern endovenous procedures at the Phlebology Clinic Key information regarding the venous embolization procedure TYPE OF TREATMENT using: ultrasound, X-ray INVASIVENESS minimum (1/5) TREATMENT AREA abdominal cavity, pelvis PERFORMING ENSEMBLE interventional radiologist, phlebologist, anesthesiology team, hemodynamic nurse DURATION 25-120 minutes TYPE OF ANAESTHESIA local, light sedation BOLDNESS minimum (1/5) RISK OF COMPLICATIONS minimal to low (1-2/5) CONVALESCENCE 5-14 days Price range Phlebology Price list for venous procedures performed in the vascular laboratory 1-sided venous embolisation From £10,000 Make an appointment 2-sided venous embolisation From £13,000 Make an appointment Percutaneous venous segment stenting using 1 stent From £19,000 Make an appointment venoplasty without stent under X-ray guidance From £10,000 Make an appointment venoplasty without stent with simultaneous venous embolisation from £15,000 Make an appointment Patient preparation for the venous embolization procedure Proper preparation of the patient for the venous embolization procedure is a crucial step that aims to ensure the safety and effectiveness of the procedure, as well as to rule out other pathologies mimicking venous disease of the pelvis and abdominal cavity (e.g., adhesions or endometriosis in women!). The preparatory process includes several important diagnostic and organizational steps (we advise patients against remote qualification for this type of procedure). it all starts with a phlebological consultation with a comprehensive assessment of the veins using Doppler ultrasound: this step cannot be skipped. The Doppler ultrasound examination of the veins is often supplemented by other imaging modalities (so-called extended imaging diagnostics). additional imaging tests: depending on the needs and clinical findings of the phlebologist, more advanced imaging tests may be performed, such as: computed tomography venography (CTV), magnetic resonance venography (MRV), or phlebography and varicography. After diagnosis and clinical evaluation of the patient, a personalized treatment plan is prepared. closer to the date of the procedure, the patient is informed about the course of the procedure and possible methods of anesthesia (most often it is light sedation); 6-8 hours before the venous embolization procedure, you should refrain from eating and drinking (remain fasting). Some medications may require temporary discontinuation – the attending physician will make this decision and provide specific recommendations. it is necessary to arrange transportation home – driving is not allowed immediately after sedation; the total stay in the day hospital ward is 3 to 6 hours. Description of the venous embolization procedure The venous embolization procedure at the Phlebology Clinic is performed by a team of experienced specialists including a phlebologist, radiologist, interventional radiologist, and, if necessary, a vascular surgeon. The operators are always accompanied by an anesthesiology team. At the Phlebology Clinic, we only use percutaneous access, performed under ultrasound guidance with local anesthesia. Women most often have a urinary catheter inserted just before the venous embolization procedure. The venous embolization procedure proceeds as follows:The patient is locally anesthetized and undergoes light sedation just before the procedure (patient contact with the performing team is necessary); under the guidance of an ultrasound probe, and later a C-arm, the operator introduces a thin catheter over a guidewire into the target venous vessel; through the vascular catheter, embolization materials are introduced, which close the insufficient venous vessel; after closing the insufficient vein, venous plexus, or varicose veins – the vascular catheter is removed from the patient's body; a small pressure dressing is applied at the percutaneous access site to the venous vessel.The duration of the venous embolization procedure depends on the type of procedure and its complexity. It usually ranges from 20 minutes to 2 hours. Return home after the procedure usually takes place after 3-6 hours of stay in the day hospital ward. The patient leaves the ward accompanied by an adult. Management after the venous embolization procedure Each patient after a venous embolization procedure at our Clinic receives detailed written recommendations. Upon discharge from the ward, a prescription for necessary medications is issued. After venous embolization procedures, the following is also recommended: rest on the day of the procedure and for the following 4-5 days after the embolization procedure; use of prescribed pain relievers if needed; observation of the puncture site for redness or swelling; abstinence from lifting heavy objects and avoidance of intense physical exertion for about 10-14 days after the procedure; avoiding long air travel for 2-3 days after the procedure; in the case of individuals with lower limb venous insufficiency, we recommend wearing compression stockings during the postoperative period. Return to sports activities after venous embolization procedures usually occurs after 10-14 days. Contraindications to the venous embolization procedure Typical contraindications to the venous embolization procedure include: active infection, especially with a concurrent cough; pregnancy; uncontrolled or worsening chronic diseases; significant allergy to contrast agents or the embolization materials used. Possible complications after the venous embolization procedure Venous embolization, although a minimally invasive and safe procedure, like any medical procedure, may be associated with certain complications. At Klinika Flebologii, thanks to our experienced team, anesthesiological care, and modern surgical techniques, the complication rate is very low (below 5%), and most of them are transient and do not require additional treatment. Early complications (up to 24 hours after the procedure): related to the establishment of vascular access: hematoma at the puncture site, local redness and tenderness, infection of the puncture site; related to the surgical procedure: allergic reaction to the contrast agent (usually mild); transient pain in the embolized area (most often in the lower abdomen and to the left of the spine), displacement of the embolization material (extremely rare with the surgical techniques we use). Intermediate-early complications (up to 2 weeks after the venous embolization procedure): post-embolization syndrome: the main component of post-embolization syndrome is lower abdominal pain resembling menstruation in women (according to our research, it affects about 40% of embolized female patients); a slight increase in body temperature (rarely fever) lasting for 2-3 days; general weakness and transient nausea. urinary tract inflammation or infection (occurs in women after the insertion of a urinary catheter). Late complications (more than 2 weeks after the procedure): related to the embolization material used: displacement of the embolization material (practically unheard of at this stage); incomplete closure of the venous vessel or venous outflow requiring a repeat procedure (this often happens in cases of so-called partial venous embolizations, when one venous outflow is closed and there is a need to exclude, for example, 3 venous trunks causing pelvic varicose veins from the circulation). related to the healing process: persistent pain in the projection of the lower abdomen or in the projection of the inguinal canal or scrotum in men; usually resolves after 2-5 weeks. At the Phlebology Clinic we make every effort to minimise the risk of complications and our specialists remain available to patients during the recovery period. If you experience any worrying symptoms, please contact our Registry immediately. Feedback from our patients Every positive review makes us proud and motivates us to keep going. Please add feedback and share your treatment story with others ? . Do you appreciate our care? Add your opinion! Add your opinion to Google All opinions I am absolutely delighted that you are so satisfied with the professionalism of our team, the organization, and the service at Klinika Flebologii. Confirming appointments by phone is our standard; we prioritize the comfort and information of every patient. It's wonderful to hear that Dr. Cezary Szary takes the time to explain all issues and provide thorough answers to your questions. We understand that our treatments may involve certain costs and require a series of visits, which makes your positive assessment of the final outcome even more gratifying. Thank you for such a heartfelt recommendation! Monika Monique Opinia z: 5/5 Dr Venus: virtual patient counsellor Looking for an answer to your vein question? Ask our Dr. Venus! Ask Dr Venus a question Should I consult a phlebologist if I have left ovarian vein insufficiency and painful periods? Yes, you should definitely consult a phlebologist. Left ovarian vein insufficiency can lead to many health problems, including painful periods and other symptoms related to pelvic vein insufficiency."
