Enlarged pelvic veins can cause varicose veins in the legs, which are often worse when standing, exercising or cycling. Embolisation may help relieve pelvic pain caused by pelvic congestion. There are several ways to treat pelvic veins, including open groin surgery, laparoscopic surgery and minimally invasive interventional radiology. Interventional radiology uses x-rays to guide a small tube to the vein to block it; only a small three to four millimetre incision in the neck is needed. It is performed as a day case procedure.

Embolisation is less invasive than surgery, with fewer risks and faster recovery. Your consultant and the radiologist performing the embolisation will have discussed your case and feel that this treatment is most appropriate for you. You will have the opportunity to talk with them and are not obliged to give your consent to the procedure if you do not want it.

It is important that you understand the risks and benefits of any procedure before giving your consent for treatment. If you have any questions or concerns, or have not received enough information about the procedure, please discuss this with us before you sign the consent form.

• think you may be pregnant
• take any medication to thin your blood, such as clopidogrel Plavix®), prasugrel (Efient®), rivaroxaban (Xarelto®) apixaban (Eliquis®) or edoxaban (Savaysa®, Lixiana®), heparin injections, warfarin, and aspirin
• are allergic to anything including latex
• felt unwell after a previous x-ray injection

This is very important!

If any of the above apply to you, and you do not inform us in advance your procedure may have to be cancelled.

Please take all medication as normal apart from the following:

• Warfarin (also Acenocoumarol (Sinthrome®) or Phenindione (Dindevan®): these have to be stopped for five days prior to the procedure. Some patients need to have a type of heparin as a temporary alternative and this should have been arranged with your consultant’s team. You will need a blood test on the day before your procedure to check your clotting times.
• Rivaroxaban (Xarelto®) and dabigatran (Pradaxa®) apixaban (Eliquis®) or edoxaban (Savaysa®, Lixiana®) : Stop taking these two days before your procedure or as instructed.
• Heparin (e.g. dalteparin (Fragmin®) or enoxaparin (Clexane®): stop taking these the day before your procedure or as instructed
• Clopidogrel (Plavix®), prasugrel (Efient®) or ticagrelor (Brilique®): stop taking these seven days before your procedure unless you have cardiac stents. Please discuss with your doctor.
• Aspirin: stop taking this five days before your procedure unless you have cardiac stents. Please discuss with your doctor.
• Some herbal remedies: should be stopped two weeks before the procedure. Please discuss with your doctor.

You must discuss all these medications with the consultant in charge of your care as each individual may need specific advice for example if your kidneys are not working fully the anticoagulants may need stopping for longer.

• You must stop eating six hours before your procedure.  You may drink clear, non-milky fluids, such as black tea, black coffee or water up to two hours before the procedure.  For the two hours before the procedure you must not eat or drink.
• Please do take your normal medication with a little water apart from the specified medicines mentioned earlier.
• If you suffer from asthma or use inhalers please bring your inhaler/s with you.
• Please do not drive yourself to the hospital as you will need someone to drive you home afterwards; please do not use public transport.

A specially trained consultant called an interventional radiologist. Interventional radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.

In the x-ray department, in a specially adapted ‘screening’ room called fluoroscopy.

Before the procedure, the radiologist will explain the procedure and ask you to sign a consent form. Please feel free to ask questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure.

The procedure is performed under sterile conditions and the interventional radiologist and radiology nurse will wear sterile gowns and gloves. You will be asked to change into a hospital gown.

You will lie on the x-ray table, usually flat on your back. You may also have a monitoring device attached to your chest and finger and may be given oxygen through small tubes in your nose. You will be given sedation which relaxes you and makes you feel sleepy.

The skin and deeper tissues over the vein in your neck will be numbed with local anaesthetic and a fine tube (catheter) will be inserted into the vein. Using the x-ray equipment, the catheter will be guided into position into the refluxing veins in the pelvis.

The radiologist will block these veins, usually by injecting sclerosant foam and metal coils, and these coils will remain in the abnormal vein.

The radiologist will inject small amounts of dye down the catheter to check that the abnormal veins are being blocked; this may cause a warm sensation. Once they are blocked completely the catheter will be removed. The radiologist will then press firmly on the small puncture wound in the skin for several minutes to prevent any bleeding.

When the local anaesthetic is injected it will sting at first, but this soon wears off and the skin and deeper tissues should then feel numb. A nurse will be with you throughout the procedure to take care of you. If the procedure does become painful they will arrange for you to have more painkillers. You may feel a warm sensation for a few seconds when the dye is injected and you may feel like you are passing urine.

You will be awake during the procedure, and able to tell the radiologist if you feel any pain or discomfort.

You may have a small bruise after the procedure.

Every patient's situation is different but you can expect to be in the x-ray department for about two hours.

You will be taken back to the recovery area where nurses will monitor you, e.g. taking your pulse, blood pressure and temperature. They will also look at the skin puncture to make sure there is no bleeding from it. You will need to stay in bed for a few hours, until you have recovered.

You may be allowed home on the same day, or kept in hospital overnight. You must not drive yourself home or use public transport.

You may eat and drink normally but you should take things easy for the first few days. Please keep the puncture site dry for 24-48 hours. You may have some pain and discomfort for two or three weeks as the vein blocks off. Please take your usual painkillers.

You should be able to resume your normal activities within 24 hours.

You should avoid:

• Strenuous exercise and heavy lifting for 10 days
• Contact sports for two weeks

You should receive a follow-up outpatient appointment with your interventional radiologist approximately three months after your procedure.

Pelvic vein embolisation is a very safe procedure designed to avoid the necessity of a larger operation. However, as with any medical procedure, there are some minor risks and complications that can, infrequently, arise:

• There may be a small bruise (haematoma) around the site where the needle has been inserted. This is quite normal.
• If this becomes a large bruise contact your GP as there is the risk of infection. This may require treatment with antibiotics. Very rarely, the vein may be damaged by the catheter. This may need to be treated by surgery or another radiological procedure.
• A few patients may experience mild discomfort in the loin or pelvis afterwards which can last a few days.
• Rarely patients develop a rash due to an allergy to the dye. This responds rapidly to medical treatment, which would be given during the procedure should this occur
• There is a very small risk that a coil, used to block the vein, could migrate to your lungs. If this happens and it cannot be retrieved it can safely stay within the body and is very unlikely to cause any problems other than a cough and mild chest pain for a few days.
• It may not be possible to obtain a satisfactory result using embolisation, in which case a surgical operation may be offered.
• There is a possibility that the veins may enlarge again. This may also happen after any surgical treatment. If this happens, then the procedure may be repeated, or you may be advised to have an operation.

Despite these possible complications, the procedure is normally very safe, and is carried out with no significant side effects.

• The coils left in your body are normally compatible with MRI scanners so should be safe if you ever need to have an MRI scan. However, if having an MRI in the future please advise staff that you have had this procedure.
• The coils will not set off metal detector alarms, e.g. at airports.