IVC^® has been in practice for over 20 years providing minimally-invasive treatments for conditions including varicose veins, pelvic congestion syndrome, uterine fibroids, varicoceles, hemorrhoids, May-Thurner syndrome, and compression fractures.

Learn a little about our clinic in this interview with our physicians:

How many years has IVC been in business?

Dr. Ryan B. Nielsen: IVC has been in business for almost 20 years. We were one of the first vein treatment centers using the minimally invasive technology in the western United States.

Where is IVC located?

Dr. Jonathan Harrison: IVC is located next to the Utah Valley Hospital in Provo, in the Physician’s Plaza on the first floor.

What does accreditation mean for your business?

Dr. Carl M. Black : Accreditation is something that not all centers like ours even attempt to achieve. We have been accredited since 2015. For us, it means we adhere to the highest standards of best practices and excellence in care.

IVC is accredited by:

What is the physician’s specialty?

Dr. Mark S. Asay : The physicians practicing at IVC are all specially trained in interventional radiology. Which requires 6 years of training after medical school.

What conditions does IVC treat?

Dr. Carl M. Black : We treat a comprehensive range of all conditions relating to arterial disease to venous disease, even non-vascular things such as cancer, sometimes tumors in the kidneys, sometimes tumors in the liver, and various other disorders. We use techniques of minimally invasive surgery. That’s really the specialty of interventional radiology is image guided surgery. Where we do procedures that perhaps traditionally were done by open surgical procedures, using state-of-the-art, minimally invasive techniques.

What are minimally invasive treatments?

Dr. Ryan B. Nielsen: Minimally invasive treatments are procedures that have been developed to treat patients using less invasive techniques. So, rather than open surgeries, we use small catheters and wires where we can access the same organs or things that need to be treated. Because there are fewer incisions and its less invasive, it’s typically easier and less painful for the patient. It’s usually lower risk and typically it’s easier to recover from the procedure.

What is the care philosophy at IVC?

Dr. Carl M. Black : Our care philosophy at IVC is to tailor the experience to individual patients. Everyone’s different, we want to find out exactly what is going on with a specific patient and meet their needs. From the time they come into our door from the time they finish their care, we try to customize that experience to them and provide the best care possible.

What are the benefits of treatment in an outpatient facility?

Dr. Mark S. Asay : Treatment in an outpatient facility is preferrable because patients receive individualized care at a lower cost. Care that isn’t interrupted by emergencies and there is access to much better parking than at a hospital.

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Uterine fibroids are a common cause of pelvic pain, pressure, and heavy menstrual bleeding in women. Approximately 70% of women will develop uterine fibroids by the time they are 50.

Dr. Mark S. Asay sat down for an interview discussing uterine fibroids and uterine artery embolization:

Introduction

Dr. Asay: My name is Mark Asay. I joined the IVC practice in 2005 and I am one of the physicians in vein care at the clinic.

Dr. Mark S. Asay is fellowship-trained and board certified in interventional radiology. His expertise includes treatment of disorders of arterial and venous circulation and acute stroke intervention.

What are uterine fibroids?

Dr. Asay: Uterine fibroids are benign tumors that grow in the muscle of the uterus.

What are the symptoms of uterine fibroids?

Dr. Asay: The symptoms of uterine fibroids are typically related to the location and size of the fibroid. The fibroid can cause excessive and prolonged bleeding with menstruation. They can cause pain, back aches, they can also lead to infertility and problems with urination and bowel movements.

Who do uterine fibroids affect?

Dr. Asay: Uterine fibroids affect women of reproductive age. Uterine fibroids are influenced by progesterone and estrogen.

How are uterine fibroids diagnosed?

Dr. Asay: Uterine fibroids can be diagnosed by physical examination but typically further evaluation with an ultrasound or MRI is required.

How are uterine fibroids treated?

Dr. Asay: Uterine fibroids can be treated in several ways, first they can be treated with medications such as birth control pills or hormone blockers. They can also be treated surgically with a hysterectomy. Occasionally they can also be cut out and the fibroid itself removed. They can also be treated by embolization.

What are the advantages of uterine artery embolization?

Dr. Asay: Well, the advantages of uterine artery embolization are that fertility is preserved as opposed to a hysterectomy. No surgery is involved so there is typically less pain and much quicker recovery than the 6 weeks typically required after a hysterectomy.

How effective is embolization?

Dr. Asay: 90% of women will have significant improvement in symptoms within 2-3 months and symptom relief will continue through 6 months or longer.

How is uterine artery embolization performed?

Dr. Asay: Uterine artery embolization is performed on an x-ray table. A needle is placed into the artery in the groin and a small catheter about the size of a spaghetti noodle is introduced and placed into each of the uterine arteries. Embolic particles are slowly injected until the blood flow to the fibroids is eliminated.

Does embolization affect fertility?

Dr. Asay: Embolization can improve fertility if the fibroids are causing a problem with fertility. In a patient where there has been no fertility problems, its not well studied, but many women have gotten pregnant and carried pregnancies to term after a uterine artery embolization.

Is embolization painful?

Dr. Asay: Shortly after the procedure there can be significant pain and cramping which is typically well treated with pain medications. Women can also experience flu like symptoms for a few days to a week after the procedure.

What are the restrictions post-treatment?

Dr. Asay: The restrictions are pretty short term, usually we want a patient to avoid heavy lifting or exertion for 1-2 days and exercise for a week.

Watch the interview:

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Pelvic congestion syndrome, also called pelvic venous congestion, falls under a broader range of pelvic venous disorders which are a known, but often unrecognized cause of chronic pelvic pain.

Dr. Carl M. Black sat down for an interview answering some common questions about pelvic congestion syndrome.

Introduction

Dr. Black: My name is Carl Black, I am a board-certified interventional radiologist, and I have been with IVC since its start, almost 20 years ago.

Dr. Carl M. Black is fellowship-trained and board certified in interventional radiology. His expertise includes treatment of disorders of arterial and venous circulation, acute stroke intervention, and therapeutic embolization.

What is pelvic congestion syndrome (PCS)?

Dr. Black: Pelvic congestion syndrome is the term that’s most commonly used by the public for an entity that causes chronic pelvic pain and discomfort. It’s part of a spectrum of pelvic venous disorders that create an increased pressure inside the veins in the pelvis that can push on the ovaries and the uterus and create chronic nagging pain.

Are there other names for PCS?

Dr. Black: So pelvic congestion syndrome is also known as pelvic venous hypertension, pelvic venous congestion, and more recently, the preferred term is pelvic venous disorder. And the reason we refer to it as a pelvic venous disorder is that the congestion or increased pressure in the veins in the pelvis can be caused by reflux, perhaps a leaky valve in one of the ovarian veins. Or it can be caused by an obstruction of a vein that would normally take blood out of the pelvis. We have to evaluate all potential causes of pelvic congestion to make sure we can tailor a therapy to a specific patient and meet their needs.

What are the symptoms of PCS?

Dr. Black: The symptoms of pelvic congestion syndrome are mainly chronic, dull, heaviness in the pelvis. Patients will often feel that pain more toward the end of the day after they have been on their feet for a long period of time. They will feel better in the morning. It’s often reproducible simply by position, whether they are standing or laying down. Sometimes after sexual intercourse, it can have a prolonged nagging pain. But probably the most common symptom someone describes is a chronic nagging heaviness in the pelvis. It’s estimated that of patients with pelvic pain that go undiagnosed, almost 30% of those patients will have at least some element of pelvic congestion.

How do you diagnose PCS?

Dr. Black: Diagnosing and managing pelvic congestion, it’s important that we evaluate all possibilities. We want to make sure someone does not have a problem with a tumor or a problem with their ovary or some other issue. Maybe it could be chronic inflammation in the pelvis. Maybe it could be an adhesion or a scar from a prior surgery. We do thorough imaging work up that includes ultrasound where we look in a detailed way at the uterus, at the ovaries, and the other structures in the pelvis. We can also use tools such as venography that looks at the actual blood flow inside of these veins and in that way, we can with almost 90% certainty know that someone has pelvic congestion and that is the cause of their pain or some other entity that we need to help them get to another specialist to treat.

Who does PCS typically affect?

Dr. Black: Pelvic congestion usually affects women in their childbearing years. It is often women who have had multiple children. Pregnancy is a stressor on the body, on the physiology and tends to put a lot of pressure on the veins in the pelvis. So physiologically after several pregnancies, if somebody is going to develop pelvic congestion, pregnancy will often exacerbate those symptoms and bring it to the forefront.

Up to 30% of patients with chronic pelvic pain have a pelvic venous disorder.

How is PCS treated?

Dr. Black: We treat pelvic congestion typically with embolization. An embolization is an occlusion of the diseased vein. Once we have gone through our diagnostic steps and we understand what is going on with an individual patient, we can drive a catheter inside of those veins. Those diseased veins, using imaging guidance. And using coils and different substances such as a sclerosant we can occlude these disease veins so that blood no longer pools in the pelvis and causes pain. In some cases, patients may have an obstruction of a large vein that would typically drain the pelvis. Such as an iliac vein that may drain the leg. In those cases, we would put in a stent to open up that vein to relieve the pressure. So, embolization is our primary treatment, I would say, in most of our cases.

How is embolization performed?

Dr. Black: Embolization of pelvic congestion is performed using a minimally invasive procedure where we take a catheter, a small tube, and we guide it inside of the vein that’s actually diseased. The vein that has refluxing valves or insufficient valves. Once we are in that vein, and we can confirm the typical pattern of blood flow, we can then occlude that vein using a combination of small coils and a substance called a sclerosant. That combination will close and scar the vein down so that blood can no longer pool in the pelvis and cause chronic pain.

Is embolization painful?

Dr. Black: Embolization can cause mild discomfort in the pelvis. That can linger for a few days to a few weeks. We typically tell patients to wait 2-3 months before they see the full impact of embolization on their condition. We perform embolization with sedation. Meaning that we give patients medication to help them relax and feel less anxious about their procedure. And that usually takes the edge of enough the procedure is comfortable and patients tolerate it very well.

Does embolization affect fertility?

Dr. Black: Embolization does not affect fertility. Research has shown that it does not affect the function of the ovaries or the normal physiology of someone’s body. Patients can have successful pregnancies and continue to have normal menstrual cycles after embolization.

Are there any restrictions post-treatment?

Dr. Black: The recovery from embolization is usually quite straightforward. After we are done in our clinic, we will keep patients 1-2 hours, mostly to make sure they recover from sedation appropriately. Once they are home, we encourage patients to stay very active. In fact, we would like them to resume most normal daily activities after they leave our clinic. Because they have received sedation, we don’t want anybody driving or making important decisions the day of their procedure. But after that, they can pretty much resume most normal activities. For about 2 weeks, we want patients to avoid heavy lifting because we do not want to stress those veins we are trying to close down.

How long before the patient feels relief?

Dr. Black: They will generally receive their full benefit at about 2-3 months after the procedure.

How effective is PCS treatment?

Dr. Black: Our treatment of pelvic congestion is successful in over 85% of patients. It’s not 100%. And the reason it’s not 100% is pelvic pain is complex. Lots of things can cause pelvic pain but in patients who have a typical history and go through the steps that we take to confirm that diagnosis, 85% of those patients will feel significant relief and have an excellent outcome. The other 15% may have other issues that we need to refer them to a gynecologist to treat or there may be some other issue we can treat that are unrelated to pelvic congestion. Such as a tumor on the uterus, such as a fibroid, that we will treat through embolization.

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Varicoceles are enlarged varicose veins that occur in the scrotum. Besides being painful, they can cause problems with fertility. Studies indicate approximately 15% of men suffer from varicoceles and 40% in males who have fertility issues.

We interviewed Dr. Jonathan Harrison on varicoceles and how they are treated. Here is what he had to say:

Introduction

Dr. Harrison: My name is Jonathan Harrison. I have been at IVC for approximately 3 years. I previously practiced in Las Vegas for 3 years as well.

Dr. Jonathan Harrison is fellowship-trained and board certified in interventional radiology. His expertise includes treatment of disorders of arterial and venous circulation, acute stroke intervention, and therapeutic embolization.

What is a varicocele?

Dr. Harrison: A varicocele is a small little cluster of veins, varicose veins, that occur in the scrotum. Most varicose veins occur because of reflux or incompetent or inefficient veins. And the same thing is happening in the scrotum. The actual vein that is happening in is called the spermatic vein.

What are the symptoms of a varicocele?

Dr. Harrison: The symptoms of varicocele are very common amongst patients. First of all, its all male because its in the spermatic vein and the varicose veins are occurring in the scrotum. The symptoms when you have these is a dull aching pain that is more severe when you have been standing for much of the day or when you have been doing a lot of exercise or a lot of work that requires a lot of lifting.

Who does a varicocele typically affect?

Dr. Harrison: Varicoceles affect approximately 10-15% of the general population of males. Sometimes a male may have a varicocele and not even know that they have it. They present typically present to us because they have been having the symptoms that we have talked about.

How are varicoceles diagnosed?

Dr. Harrison: Varicoceles are diagnosed by clinical symptoms, number 1. And number 2, with an ultrasound of the scrotum.

Do varicoceles affect fertility?

Dr. Harrison: Varicoceles can affect fertility. We have found that males who experience infertility issues, 30-40% of them have a varicocele. The mechanism in which this occurs, we think, is secondary to increased temperature that occurs around the scrotum because of these varicose veins. That increased temperature can inhibit sperm production and make fertility issues more prominent.

40% of men who experience fertility problems have a varicocele.

How are varicoceles treated?

Dr. Harrison: So, there are two ways in which a varicocele can be treated. Traditionally you can go the surgical route. Surgical route occurs in which you go to surgery and they identify the veins that are incompetent, these spermatic veins, and they actually go in and they clip them, surgically. So they don’t have any more problems with reflux. The more recent development in treatment is called varicocele embolization, which we specialize in. Varicocele embolization is where we go endovascularly into these veins with little tiny wires and catheters and we insert a little bit of irritative foam or little titanium coils into the vein and close those veins down so that reflux doesn’t occur anymore. Thereby resolving the varicocele.

What are the advantages of varicocele embolization?

Dr. Harrison: The advantages of varicocele embolization are many. First of all, when you compare them to the actual surgery that can also be done for this, the embolization is minimally invasive. Therefore, on the day of your procedure you’re coming in in the morning, you are getting your procedure done, it takes about an hour to do it. And then you’re leaving about two hours later. The other advantage for varicocele embolization is it is more affordable versus surgery. The outcomes between the two, surgery and embolization, are equivalent. You’re not getting any difference in outcomes between the two.

How effective is embolization?

Dr. Harrison: We have found that it is very effective. First of all, what we are trying to do is twofold. If you are coming in because of pain or discomfort, we have found that over 75% of patients report vastly improved discomfort and pain several months after the procedure. If you are coming in for fertility issues, we have found greatly increased predictors of improved fertility. Those predictors are mainly focused on the semen quality and the sperm count and sperm motility.

Is embolization painful?

Dr. Harrison: The actual procedure of embolization is not painful. You do, and it is common to have a little bit of discomfort afterwards for one or two days in the form of back pain or a little bit of scrotal swelling.

How is the recovery from embolization?

Dr. Harrison: The recovery of embolization is very easy. You are able to go to work the next day. Then you are able to manage any mild discomfort with Tylenol or with ibuprofen.

How long before the patient feels relief?

Dr. Harrison: The symptomatic relief that a patient will feel from a varicocele embolization will occur within the first few weeks after the procedure is done, if they are coming in for pain and discomfort. If they are coming in for fertility issues, it typically takes about three months for the improved sperm production and semen quality to get up to where it should be.

Are there any restrictions post-treatment?

Dr. Harrison: The restrictions post-treatment for a varicocele embolization are very minor. We ask that a patient abstains from physical activity for about three days. They are able to go to work the next day. But after that you can participate in all normal activities.

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Deep vein thrombosis, commonly described as DVT, occurs when a blood clot occurs in a deep vein. This can impede the blood flow in the extremity causing pain, swelling, and redness. It is important to seek care if you suspect you have DVT as it can lead to a serious condition called pulmonary embolism.

Dr. Ryan B. Nielsen sat down to discuss DVT and how it may be treated:

Introduction

Dr. Nielsen: I am Dr. Ryan Nielsen. I am an Interventional Radiologist. I have been with Utah Radiology Associates for over 20 years, and I’ve been with IVC since its inception.

Dr. Ryan B. Nielsen is fellowship-trained and board certified in interventional radiology. His expertise includes treatment of disorders of arterial and venous circulation, acute stroke intervention, and therapeutic embolization.

What Is DVT?

Dr. Nielsen DVT is a blood clot. The word DVT, the acronym, means deep vein thrombosis. So specifically, it’s a blood clot that occurs in a deep vein. Which typically are the veins in your legs.

What causes DVT?

Dr. Nielsen: DVT is caused by what’s called Virchow’s Triad. It was described by a scientist/physician named Virchow and the components that cause DVT are venous stasis, which means the blood is stagnant, an injury to the vessel, and the third component is hypercoagulability. Or propensity for the blood to form clots which can be genetic or can be based on different factors.

Who does DVT typically affect?

Dr. Nielsen: DVT can affect anyone, particularly those who have the factors described in Virchow’s Triad. So, anyone who has venous stasis, anyone who has sustained some kind of vascular injury, or somebody who has hypercoagulability or a propensity to form blood clots. Those can be temporary, or they can be permanent. So, there are factor that increase your likelihood of clots. Such as, having venous stasis, pregnancy, people on oral contraceptive pills, someone who has recently had surgery, or has recently had trauma among other things.

Is DVT life threatening?

Dr. Nielsen: DVT in and of itself is not life threatening, it just causes leg swelling and pain. However, the condition of DVT can be life threatening because sometimes that clot, if it is unstable can break off from the leg and go up the vena cava, through the heart, and into the lungs. Which is called a pulmonary embolism. A pulmonary embolism reduces your ability to pump blood to the lungs and get oxygenated blood and that can be fatal.

What is the difference between acute and chronic DVT?

Dr. Nielsen: DVT can be acute or chronic. Acute means it happened recently. And that’s typically within days to up to three weeks. After about three weeks, the body starts to try to dissolve the clot and the clot starts to become fibrinous or firm and eventually becomes almost like scar tissue adherent to the wall of the vein, and that is chronic DVT.

How is DVT diagnosed?

Dr. Nielsen: DVT is generally diagnosed initially clinically. People will have leg pain and leg swelling are the most common symptoms. And with imaging it’s typically diagnosed with ultrasound.

How is DVT treated?

Dr. Nielsen: DVT is treated in a couple of different ways. In the acute setting, it can be treated with both medications, the standard treatment has been just an oral pill that you take, either coumadin or warfarin or other pills that thin the blood and help to dissolve the clot. More recently in the last several years, acute DVT has been treated by directly infusing medications that dissolve the clot or using mechanical devices that can suck out or pull out the clot. Chronic DVT is a different thing. That’s adherent to the vein wall so you really can’t get it out. But it can cause obstruction to venous flow and cause increased pressure in the veins. So, that can be treated by balloon angioplasty or stent placement.

How successful are DVT treatments?

Dr. Nielsen: DVT treatments are very successful in the acute phase. If you catch it early, ideally within three weeks or less, almost always the medications or pharmacological and mechanical thrombectomy, the treatments, can remove that acute DVT. With the chronic DVT, it’s much more difficult to treat because it is like scar tissue. So, we are not really treating the clot itself, we are treating the problems it causes. Like narrowing in the vein, which needs to be opened with a stent or balloon angioplasty.

How long before the patient feels relief?

Dr. Nielsen: If we are treating an acute DVT with pharmacological and mechanical thrombectomy, which means we are going in and removing the clot. Most often the patient will feel relief very quickly. Because we have removed the clot that’s causing the pressure and the swelling in the vein and the leg. If you treat it with typical oral medications, it can take several days to weeks before it starts to feel better because it takes that long for the body and medication to dissolve the clot. So typically, we are trying to get acute DVT and treat it immediately with those mechanical devices and blood thinning drugs so we can give somebody fairly immediate relief.

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“It is certainly IAC’s pleasure to recognize these facilities for their longstanding commitment to quality as demonstrated through continuous achievement of IAC accreditation. We look forward to our ongoing relationship and celebrating each additional title that is added in the coming years! Newly qualifying facilities can look forward to receiving their awards this year, a tangible testament to quality that is meaningful both to their staff who see the award every day and the patients they serve.”

IAC is an interdisciplinary accreditation body that oversees the practice and management of varicose vein treatment. To achieve accreditation all processes in the evaluation and treatment of varicose veins are scrutinized. Ultrasound images are submitted for evaluation, proper certifications must be held and maintained, providers and ultrasound technicians must attend continuing education, protocols set in place, and an on-site visit from IAC to view the practice in action. This means our patients may be assured that they are receiving high-quality, comprehensive varicose vein care.

IVC^® prides itself in being one of the few varicose vein treatment specialists in Utah to offer the full range of procedures to treat vein disease. A complete varicose vein treatment plan often includes vein ablation (endovenous radio-frequency ablation, endovenous laser ablation, VenaSeal, ClariVein) to treat main sources of reflux, ambulatory phlebectomy to treat obvious bulging varicose veins, and sclerotherapy to treat smaller varicose veins. We also perform ovarian or gonadal vein embolization for the treatment of pelvic congestion syndrome and varicoceles, as well as treating venous obstruction disorders like May-Thurner disease.

IVC^® looks forward to continuing to provide the communities of Utah Valley and surrounding areas with excellent varicose vein treatment and to continuing to meet the qualifications of the Intersocietal Accreditation Committee.

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Who gets varicoceles?

• Varicoceles affect 10% of men
• They are most common in younger men between the ages 20 and 40

Signs and Symptoms

Most varicoceles don’t cause any symptoms and can be left untreated without causing any harm. However, many cases result in:>

• Pain – Dull or sharp pain that gets worse when standing or sitting for extended periods of time.
• Infertility – Varicoceles may lead to a decreased sperm count, low sperm movement, or more sperm that are deformed
• Enlargement – Varicoceles may swell and become more noticeable over time
• Atrophy – Shrinkage of one or both testicles

Diagnosis

Physical exam

Many cases of varicoceles are detected during routine physical exams. Your doctor may be able to feel the mass which may seem like a bag of worms next to the testicle.

Ultrasound

Your doctor may order an ultrasound to exclude other reasons for your symptoms, such as a tumor.

Treating varicoceles

While many varicoceles are still treated with conventional surgery, there is a new minimally invasive alternative known as varicocele embolization.

Varicocele embolization

• A small catheter is inserted into a neck or groin vein
• The catheter is guided into the gonadal vein
• Tiny metal coils and sclerosant are injected into the diseased vein
• Patients are observed for a few hours before going home

Advantages of varicocele embolization

• No surgical incision
• No general anesthesia
• Low rate of complications
• Less recovery time, men are usually able to return to work the very next day with timely relief of symptoms.

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Understanding how veins work helps to understand how DVT develops. Healthy veins return blood to the heart through one-way valves, which prevent the backward flow of blood. Diseased veins have weakened valves, allowing blood to flow backwards, pooling in the veins, and increasing risk of DVT and other complications.

Chronic DVT often causes venous scarring and obstruction, which may lead to swelling, pain, and changes in the skin, including skin ulceration.

Risk factors for DVT

• Long periods of inactivity
• Major surgery
• Extended travel
• Narrowed veins
• Pregnancy
• Trauma or injury
• Oral contraceptives
• Blood clotting disorders
• Obesity
• Family history of DVT

Approximately 1 in 1,000 people will develop DVT in their lifetime.

What are the symptoms of dvt?

• Painful, swollen legs
• Redness or discoloration of skin
• Skin ulceration may occur with chronic DVT
• Shortness of breath or chest pain in cases of pulmonary embolism (clot in lung artery)

How is DVT diagnosed?

Ultrasound

This is considered the non-invasive gold standard in detection of acute DVT.

Blood tests

Patients with DVT usually have an elevated D-dimer. In some situations, additional testing may be indicated to determine genetic risks for DVT.

Other

Occasionally, other specialized imaging techniques such as venography or CT may be needed for a full evaluation, particularly in cases of extensive, more central DVT.

Acute vs. chronic DVT

Acute DVT

Describes a blood clot, or thrombus, that is less than two weeks old. In severe cases, an acute clot can often be removed by endovascular mechanical thrombectomy and/or thrombolysis. The goal of treatment is to restore blood flow and prevent longer-term complications associated with vein scarring and occlusion.

Chronic DVT

After several weeks, DVT becomes fibrotic and scars the involved veins which can obstruct blood flow back to the heart. Patients with chronic DVT often experience chronic leg swelling and pain, skin discoloration, and even skin ulceration. In many severe cases, chronic DVT obstructions can be treated using angioplasty and stenting to improve blood flow.

What are DVT treatment options?

Blood thinners

Injectable and pill-form blood thinner medications are commonly used to prevent further clotting.

Thrombolysis/ thrombectomy

For serious DVT cases that involve larger, more central deep veins, clot can often be removed in order to restore normal flow and prevent scarring and vein occlusion.

Vena cava filter

This treatment method is reserved for situations when blood thinners are contraindicated or ineffective. The filter prevents large blood clots from passing to the lungs. Filters are typically temporary and are ideally removed when no longer needed.

Compression stockings

Worn from the feet to the knees or thighs, these medical-grade stockings help minimize swelling that occurs with DVT and improve circulation.

Venous revascularization

In cases where chronic DVT has resulted in severe symptoms such as leg swelling, skin discoloration and skin ulceration, the larger critical veins may be reopened using angioplasty and stents in order to improve blood flow.

Preventing DVT

These are some things you can do to reduce the risk of developing DVT:

• Avoid prolonged sitting
• Exercise regularly
• Make healthy life choices

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Compression

Using compression stockings can provide external pressure to the venous system encouraging blood flow out of the legs. Blood is moved through the veins when the muscles surrounding the veins squeezes and applies pressure to the vein walls forcing the blood to move upward. Compression stockings cannot apply this same amount of pressure as muscles do, but the pressure that is applied by the stocking works in the same manner. We recommend using 20-30 mmHg compression stockings.

Activity

Vein walls are much thinner than arterial walls and do not have the same smooth muscle composition as arteries. Veins are dependent on the muscles surrounding the vein to squeeze and force the venous blood up through the valves. If patients have regular activity then they have more muscle compression on the veins improving venous flow.

Elevation

When compression is not applied to the vein then fluid will always be gravity dependent. If you are standing or sitting the blood in your veins will naturally want to go to the lower leg. The fluid outside of the vein will do the same thing settling in the foot and ankles. By elevating your legs above the level of your heart you will encourage the blood/fluid to return towards the heart and out of the legs.

These three things will not cure vein disease or damaged valves. Damaged valves within the vein are not able to repair themselves, though by applying these principles you may be able to prevent worsening of venous insufficiency of the deep system.

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Pelvic congestion syndrome, also called pelvic venous congestion, falls under a broader range of pelvic venous disorders which are a known, but often unrecognized cause of chronic pelvic pain. Varicose pelvic veins develop when the valves in veins are not working correctly, or occasionally when critical deeper veins are obstructed, causing blood to pool and distend pelvic veins.

To explain pelvic congestion syndrome, it it helps to understand the purpose of veins in the body:

Healthy veins return blood to the heart through one-way valves, allowing blood to travel toward the heart. Congested veins have weakened valves, allowing blood to flow backward and pool distend and pelvic veins.

Occasionally, increased pressure inside pelvic veins may be the result of an obstruction in the major veins draining the pelvis.

Commonly Recognized Associations

It is estimated that 30% of patients with chronic pelvic pain of an unknown cause actually suffer from a symptomatic pelvic venous disorder. Although the causes of pelvic venous congestion are complex and poorly understood, a few commonly recognized associations include:

• Family history of venous disease
• Multiple pregnancies
• Estrogen
• Pelvic or renal vein compression

What Are the Symptoms of Pelvic Congestion Syndrome?

Typical symptoms of pelvic congestion include:

• Increased urination frequency
• Bloating sensation
• Visible varicose veins on the buttocks, vulva, and upper thighs
• Dull achiness and/or heaviness in the pelvis, often made worse by prolonged standing
• Painful menstrual cycles with referred pain in the legs
• Pain during and after intercourse

How Is Pelvic Venous Congestion Diagnosed?

Unfortunately, pelvic venous congestion often goes unrecognized and untreated. Symptoms, physical exam and ultrasound findings have a high combined predictive value in diagnosing pelvic venous disorders. The ability of duplex ultrasound (DUS) to image real-time makes it an important tool in the evaluation of possible pelvic venous congestion.

Because there are many other potential causes of chronic pelvic pain, medical professionals may conduct multiple exams and tests including:

• Pelvic exam
• Pelvic duplex ultrasound
• CT or MRI scan
• Laparoscopy

In our office, a nurse practitioner, physician’s assistant, or physician will discuss pelvic symptoms with you. They will determine whether you present with pelvic congestion syndrome symptoms and order an ultrasound to look for varicose veins in the pelvis, labial area, and upper thigh. This gives information regarding the sizes of the varicose veins in the pelvis and whether they have propagated to other parts of the body. Once these veins are found, they will also order a CT scan to show the origin of the varicose veins.

Treatment

Once a patient is diagnosed with pelvic venous congestion, it can often be successfully treated with a minimally invasive procedure called embolization. Pelvic venous embolization requires little or no downtime and is performed in an outpatient setting. Occasionally, a compressed iliac vein may contribute to venous congestion and a stent may be indicated to help restore normal flow.

Benefits of embolization:

• Requires little or no downtime
• Performed as an outpatient
• Minimally invasive, but highly effective

After treatment, patients are typically able to return to most routine activities the same day.

Ovarian Vein Embolization Treatment Tips

• Wear comfortable clothing to the procedure
• Eat a light meal the evening before your procedure
• Don’t eat or drink less than 6 hours before treatment, unless directed by your doctor
• Over-the-counter pain medication is typically all that is needed after the procedure
• While recovering, stay active but avoid heavy lifting
• Reach out to your treating doctor with any questions or concerns

Follow Up

We always follow-up with the patient approximately one month post venogram to see if some you the patient’s symptoms have resolved. It may take 1-2 menstrual cycles before significant relief is noticed. Most women we have seen in the office for their post venogram follow-up have described some cramping for the first few days post procedure, and with significant relief in the weeks and months after.

For more information on pelvic congestion syndrome visit: Pelvic Congestion Syndrome

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