Women have unique health issues. Some of these unique health issues can include pregnancy, menopause, and conditions of the female organs. At the Vascular Institute of Virginia, we specialize in treating some of the unique health conditions that can affect the female population.
- Uterine Fibroid Embolization
- Ovarian Vein Embolization (OVE) for Pelvic Congestion Syndrome
- Varicose Vein
- Fallopian Tube Recanalization
Uterine Fibroid Embolization (UFE)
Some fibroids produce mild or no symptoms, while others can cause considerable pain/pressure and limit your lifestyle. The most common symptoms are:
• Heavy or frequent menstrual periods
• Pelvic pain/pressure
• Pain during or after sexual intercourse
• Urinary frequency
• Constipation and/or bloating
• Abnormally enlarged abdomen
What are Uterine Fibroids?
Uterine fibroids are very common non-cancerous (benign) growths that develop in the muscular wall of the uterus. They are most common among women of childbearing age and more prevalent among African-American women. Fibroids are the cause of more than 200,000 hysterectomies every year. Fibroids are classified according to their location in the uterus.
While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding. Subserosal fibroids develop under the outside covering of the uterus and expand outward through the wall. They can cause pelvic pain, back pain and generalized pressure. Intramural fibroids develop within the lining of the uterus and expand inward. These are the most common type and can result in heavier menstural bleeding and pelvic pain, or back pain. Submucosal fibroids develop just under the lining of the uterus. Even a very small submucosal fibroid can cause heavy bleeding (gushing) and very prolonged periods.
Diagnosing Uterine Fibroids:
Some women live with fibroids and do not have any symptoms. Routine gynecologic exams, detailed description of symptoms, and certain imaging studies can accurately diagnose fibroids. These imaging
studies can include ultrasound, magnetic resonance (MRI) or computed tomography (CT) of the pelvis.
Based on your medical history, severity of symptoms, and location and size of your fibroids, your options for treatment may include:
• Medications (these only treat symptoms and do not have a direct effect on the fibroids)
• Surgery (myomectomy or hysterectomy)
• Non-surgical treatment (Uterine Fibroid Embolization)
What is Uterine Fibroid Embolization?
Uterine fibroid embolization (UFE), also known as uterine artery embolization, is performed by an interventional radiologist, a physician who is trained to perform this and other types of embolization and minimally invasive procedures. It is performed while the patient is conscious, but sedated and feeling no pain. It does not require general anesthesia. The interventional radiologist makes a tiny nick in the skin in the groin and inserts a microcatheter into the femoral artery. Using real-time imaging, the physician guides the microcatheter through the artery and then releases small spheres, the size of grains of sand, into the uterine arteries that supply blood to the fibroid tumor. This blocks the blood flow to the fibroid tumor and causes it to shrink and reabsorb over time.
The Advantages of UFE
• Preserves the uterus
• Minimally invasive
• Low complication rate
• Short recovery time
• Treats all the fibroids with one procedure
• Recurrence is rare
• No adhesions or scar tissue
• General anesthesia not necessary
What should you expect after a UFE procedure?
• You will be prescribed medications for pain management
• You may not drive while taking the prescription pain medication
• Symptoms will markedly improve in 90% of patients
• Treated fibroids rarely recur
• You will need to take off work 1-2 weeks (compared to 4-6 weeks for surgical procedures.)
Ovarian Vein Embolization (OVE) for Pelvic Congestion Syndrome
What are the symptoms?
Dull, aching pain is usually felt in the lower abdomen and lower back. You may experience:
• Deep pelvic pain when sitting or standing, worsening throughout the day
• Bulging veins on the vulva,
buttocks or thighs
• Painful/irregular menstrual cycles
• Pain during/after intercourse
• Irritable bladder
Who’s at Risk?
• Women less than 45 years old
• Women in their childbearing years
• Women who have had two or more pregnancies
• Women with hormonal dysfunction
• Women with polycystic ovaries
What is Pelvic Congestion Syndrome?
Pelvic congestion syndrome, also known as ovarian vein reflux, is the second leading cause of chronic pelvic pain in women, after endometriosis, and can potentially lead to significant disability resulting from the presence of varicose veins in the pelvis. Like varicose veins in the legs, pelvic congestion syndrome is related to malfunctioning valves within the pelvic veins. Valves in these pelvic veins normally allow blood to flow towards your heart. When the veins become weakened or the valves do not close properly, the blood can flow backward toward the pelvis. Blood in the weakened pelvic veins pools, causing the veins to bulge and push against nearby structures. This can result in pain and pressure in the uterus, ovaries, vulva and back. It is described as “non-cyclic” pain lasting greater than six months in duration. Diagnosis of the condition is done through one of several methods including; pelvic venography, magnetic resonance imaging (MRI) and pelvic and transvaginal ultrasound.
Chronic pelvic pain is very common in women and can potentially lead to significant disability. Approximately one out of every three women will suffer from pelvic pain at some point during their lifetime.
Diagnosing Pelvic Congestion:
The diagnosis is often missed because women lie down for a pelvic exam. This relieves pressure from the ovarian veins, so that the veins no longer bulge with blood, as they do while the woman is standing. Once other abnormalities or inflammation has been ruled out by a thorough pelvic exam, pelvic congestion syndrome can be diagnosed through several minimally invasive methods. These methods include MRI, pelvic ultrasound or transvaginal ultrasound.
What is Ovarian Vein Embolization?
Ovarian vein embolization (OVE) is a minimally invasive treatment for pelvic congestion syndrome that is used to close off faulty veins so they can no longer enlarge with blood, thus relieving the pain.
During this procedure, an interventional radiologist inserts a catheter into the jugular vein down into the faulty vein(s). Catheterization requires only a small nick in the skin for insertion and x-ray image guidance of the catheter to its target area. The catheter delivers Dacron filaments-bearing coils that clot the blood and seal the faulty vein. The use of the recently developed Sotradecol foam agent allows the radiologist to block even the smallest veins not previously accessible. The sealed off veins decompress and provide relief of pressure and painful symptoms.
The Importance of Blood Circulation
Blood circulation supplies the body with nutrients and oxygen and removes waste products. Together, the heart, arteries, and veins facilitate blood circulation. The heart pumps fresh, oxygen-rich blood throughout the body via the arteries. The veins channel oxygen-depleted blood back to the heart. Healthy veins are vital in maintaining good blood circulation in the body.
Veins and Valves
Valves inside the veins keep the blood moving back toward the heart. These valves prevent the force of gravity from pulling blood back down toward the feet.
When the veins are damaged, gravity will hinder normal blood flow causing blood to form pools in the weakened, damaged veins. The pooling blood causes these veins to enlarge. Twisted masses of veins beneath the surface of the skin, known as varicose veins, often result. Varicose veins are larger and located deeper in the leg than spider veins. Spider veins are small red, blue and purple veins on the surface near the skin.
Effect of Pregnancy on the Venous System
During pregnancy, many hormonal changes occur in the body that has a profound effect on the veins. Blood volume increases between 40% to 50%, while increased amounts of progesterone cause the vein walls to dilate and become less elastic.
The pressure of the fetal head in the pelvis can compress the iliac veins and obstruct venous outflow from the legs. As the baby grows, the uterus enlarges and applies pressure on important veins that return blood to the heart. This pressure can cause a slowing of the blood flow and valve damage, resulting in swelling, leg discomfort, and even varicose veins. A pregnant woman’s feet and legs may start to swell after sitting or standing for only a short time. In principle, this is a completely normal symptom. However, if your feet are already swollen when you get up in the morning, consult your doctor. While these symptoms may subside after delivery, with each subsequent pregnancy, they are less likely to completely disappear.
Pregnancy and DVT
Women who are pregnant are at a high risk for the development of a Deep Vein Thrombosis, known as DVT. One reason is due to the increased blood volume at full term.
Additionally, pregnancy causes hormonal changes that increase blood coagulability, a measure of how easily blood clots. The expanding uterus puts pressure on blood vessels, restricting blood flow from the legs and pelvis back to the heart.
Slower blood flow increases the risk of Deep Vein Thrombosis. The risk continues during the postpartum period until the woman’s hormonal levels return to their pre-pregnancy state.
Common Leg Health Problems During Pregnancy
Venous disorders and leg health problems are among the most frequent medical conditions in North America. You may experience these conditions for the first time during pregnancy. For example, swollen feet, tired aching legs and a feeling of heaviness in the legs are among everyday symptoms that pregnant women may experience.
These symptoms are especially frequent when:
• a history of varicose veins and venous disease exists in the family
• a venous condition was already present before the pregnancy
• the woman sits and stands for prolonged periods of time while pregnant
• the woman does not exercise regularly during the pregnancy, or
• the woman has had more than one pregnancy
Pregnancy plays a role in the development of varicose veins. 30% of women pregnant for the first time, and 55% of women who have had two or more full-term pregnancies develop varicose veins.Treatment of Varicose Vein
Fallopian Tube Recanalization
A common cause of female infertility is a blockage of the fallopian tubes, usually as the result of debris that has built up. Occasionally, scarring from surgery or serious infection can lead to a blockage as well. Fallopian tube recanalization (FTR) is a non-surgical procedure an interventional radiologist uses to treat these blockages.
Recanalization is the medical term for “reopening”. During the procedure, which does not require any needles or incisions, the physician will place a speculum into the vagina and pass a small plastic tube (catheter) through the cervix into the uterus. Through this liquid contrast, sometimes referred to as x-ray dye, is injected in order to visualize the uterine cavity and the fallopian tubes. This will help determine if there is a blockage and whether is on one or both sides. To clear the blockage, a smaller catheter and/or wire will be threaded through the first catheter and then into the fallopian tube.