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.
Frequently Asked Questions
What is Pelvic Congestion Syndrome?
Pelvic Congestion Syndrome (PCS) is a condition characterized by chronic pelvic pain resulting from varicose veins in the lower abdomen. It occurs when veins in the pelvis become dilated and congested, often due to hormonal changes or increased blood flow, leading to discomfort or pain, particularly on prolonged standing or sitting.
How is Pelvic Congestion Syndrome treated with embolization?
Embolization is a minimally invasive procedure used to treat PCS by blocking the problematic veins. During the procedure, a catheter is inserted through the neck or groin to access the affected veins. Small coils or other materials are then placed to block blood flow in the enlarged veins, relieving symptoms by rerouting blood through healthier veins.
What are the risks and benefits of embolization for PCS?
The benefits of embolization include relief from chronic pelvic pain and a minimally invasive approach with faster recovery compared to surgery. Risks may involve bleeding, infection, or accidental injury to nearby structures, though these are rare. Discussing the procedure with a healthcare provider can help weigh these factors based on individual health conditions.
What is the recovery time after a pelvic vein embolization?
Recovery from pelvic vein embolization is typically swift, with most patients returning to normal activities within a few days. Mild discomfort at the insertion site or fatigue can occur but usually resolves quickly. Following post-procedure instructions from healthcare providers can enhance recovery and symptom relief.
What does the use of conscious sedation involve during the procedure?
Conscious sedation is a technique used to relax and reduce discomfort during medical procedures like embolization. It involves administering medications such as Versed (midazolam) and Fentanyl, which help patients remain calm and pain-free while still being aware and able to respond to instructions.
Why is ultrasound and fluoroscopic guidance used in embolization?
Ultrasound and fluoroscopic guidance are imaging techniques that help doctors accurately position the catheter and coils during embolization. Ultrasound provides real-time images of blood flow and vein structure, while fluoroscopy offers X-ray images to guide the placement of devices, ensuring a safe and effective procedure.
What is the Seldinger technique mentioned in the procedure?
The Seldinger technique is a common method used to gain access to blood vessels. It involves inserting a needle into a vessel, threading a guide wire through the needle, and then placing a catheter over the wire. This technique minimizes trauma to the vessel and facilitates the safe introduction of medical devices.
What are Terumo gel coated detachable coils?
Terumo gel coated detachable coils are medical devices used in embolization procedures to block blood flow in targeted veins. These coils are coated with a gel that helps them expand and adhere within the vessel, effectively sealing it off to prevent blood flow and alleviate symptoms associated with vein enlargement.
What is Visipaque 320, and why is it used during embolization?
Visipaque 320 is a type of contrast agent used in imaging techniques like fluoroscopy during embolization. It enhances the visibility of veins and other structures on X-ray images, allowing doctors to accurately guide the placement of coils and confirm successful embolization of the targeted vein.