CLINICAL HISTORY: Pelvic Congestion Syndrome with pain in the left pelvis.

TECHNIQUES:
Written and oral consent was obtained after discussing risk, benefits, and alternatives, prior to the procedure. Patient decided to proceed with the procedure. Timeout was performed per protocol.

Conscious sedation using versed 1mg IV and Fentanyl 50 mcg IV was provided by certified nursing staff after normal head/neck and cardiopulmonary exam for 30 minutes. ASA 2

Procedure was done under sterile technique and local anesthesia with 1 % lidocaine.

Ultrasound and fluoroscopic guidance were used to obtained right internal jugular access using the Seldinger technique. Images were saved in the permanent records. The right neck access was replaced with a 7 French sheath.

Using 4 and a 5 French catheter and the glide wire the left renal vein was selected and venogram is obtained.

There is a markedly enlarged left gonadal vein coming off the left renal vein. No significant collateral vein is seen.

Embolization of the left gonadal vein was achieved by using a total of nine (9) Terumo gel coated detachable coils ranging in the size of 12 mm in diameter to 20 mm.

Venogram confirmed the position.

All wires and catheter was removed.

The patient tolerated the procedure well. There were no immediate complications.

Contrast: 30 ml of 100 ml bottle of Visipaque 320 was used.

IMPRESSION:

Successful embolization of the enlarged left gonadal vein using multiple platinum coils as described.

No immediate procedural or sedation competitions occurred.