Clinical Research| Volume 91, P191-200, April 2023

Venous Thromboembolism After Interventions on the Ovarian Veins in Patients With Pelvic Venous Disorder

Published:December 01, 2022DOI:


      • The incidence of venous thromboembolism (VTE) after interventions on the ovarian veins in patients with pelvic venous disorder (PeVD) is not well established.
      • We compared VTE rates after ovarian vein resection (OVR) and ovarian vein embolization (OVE) in patients with PeVD.
      • VTE was found to be more frequent after OVE with coils than after OVR (in 27% and 10% of patients, respectively; P = 0.001). The odds ratio for developing VTE after OVE with coils was 10 times higher than after OVR.


      Ovarian vein resection (OVR) and ovarian vein embolization (OVE) are effective options for treating patients with pelvic venous disorder (PeVD). However, due to in an abrupt cessation of blood flow in the ovarian veins (OVs), these interventions can be complicated by pelvic vein thrombosis (PVT). The aim of this study was to assess venous thromboembolism (VTE) rates after OVR and OVE in patients with PeVD.


      This retrospective cohort study included 272 patients with PeVD who underwent OVR (n = 122) or OVE with coils (n = 150). The rates and clinical manifestations of VTE were assessed in each group on days 1 and 3 after the intervention using duplex ultrasonography. Vein patency, blood flow velocity, and localization of thrombi in the pelvic (parametrial, uterine, and ovarian), iliac, superficial, and deep veins of the lower extremities were examined. PVT was defined as the formation of blood clots in nontarget (i.e. not intended to intervention) veins of the pelvis (parametrial, uterine veins, or tributaries of the internal iliac veins).


      VTE after OVR and OVE was identified in 52 (19%) out of 272 patients. In the OVR group, PVT and calf deep vein thrombosis were detected in 9% and 1% of patients, accordingly, while in the OVE group their rates were almost three times higher (24% and 3%; both P = 0.001). In both groups, the most common VTE was PVT. The odds ratio for developing VTE with coils was 10 times higher (95% confidence interval: 2.35–56.43) after OVE than after OVR. Clinical manifestations of PVT were observed in 2.5% of patients, and the rest patients were asymptomatic. No cases of pulmonary embolism occurred.


      VTE after interventions of the ovarian vein in patients with PeVD occurs in every fifth patient. OVE is associated with a higher incidence of PVT.
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        • Phillips D.
        • Deipolyi A.R.
        • Hesketh R.L.
        • et al.
        Pelvic congestion syndrome: etiology of pain, diagnosis, and clinical management.
        J Vasc Interv Radiol. 2014; 25: 725-733
        • Antignani P.L.
        • Lazarashvili Z.
        • Monedero J.L.
        • et al.
        Diagnosis and treatment of pelvic congestion syndrome: UIP consensus document.
        Int Angiol. 2019; 38: 265-283
        • Khilnani N.M.
        • Meissner M.H.
        • Learman L.A.
        • et al.
        Research priorities in pelvic venous disorders in women: recommendations from a multidisciplinary research consensus panel.
        J Vasc Interv Radiol. 2019; 30: 781-789
        • Guirola J.A.
        • Sanchez-Ballestin M.
        • Sierre S.
        • et al.
        A Randomized trial of endovascular embolization treatment in pelvic congestion syndrome: fibered platinum coils versus vascular plugs with 1-year clinical outcomes.
        J Vasc Interv Radiol. 2018; 29: 45-53
        • Kirienko A.I.
        • Gavrilov S.G.
        • Ianina A.M.
        • et al.
        Results of different types of operations in patients with pelvic congestion syndrome.
        Flebologiya. 2016; 10: 44-49
        • Lopez A.J.
        Female pelvic vein embolization: indications, techniques, and outcomes.
        Cardiovasc Intervent Radiol. 2015; 38: 806-820
        • Borghi C.
        • Dell'Atti L.
        Pelvic congestion syndrome: the current state of the literature.
        Arch Gynecol Obstet. 2016; 293: 291-301
        • Gavrilov S.G.
        • Sazhin A.
        • Krasavin G.
        • et al.
        Comparative analysis of the efficacy and safety of endovascular and endoscopic interventions on the gonadal veins in the treatment of pelvic congestion syndrome.
        J Vasc Surg Venous Lymphat Disord. 2021; 9: 178-186
        • Thors A.
        • Haurani M.J.
        • Gregio T.K.
        • et al.
        Endovascular intervention for pelvic congestion syndrome is justified for chronic pelvic pain relief and patient satisfaction.
        J Vasc Surg Venous Lymphat Disord. 2014; 2: 268-273
        • Whiteley M.S.
        • Dos Santos S.J.
        • Harrison C.C.
        • et al.
        Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women.
        Phlebology. 2015; 30: 706-713
        • Lenz C.J.
        • Wysokinski W.E.
        • Henkin S.
        • et al.
        Ovarian vein thrombosis: incidence of recurrent venous thromboembolism and survival.
        Obstet Gynecol. 2017; 130: 1127-1135
        • Kodali N.
        • Veytsman I.
        • Martyr S.
        • et al.
        Diagnosis and management of ovarian vein thrombosis in a healthy individual: a case report and a literature review.
        J Thromb Haemost. 2017; 15: 242-245
        • O'Brien M.
        • Gillespie D.
        Diagnosis and treatment of the pelvic congestion syndrome.
        J Vasc Surg Venous Lymphat Disord. 2015; 3: 96-106
        • Whiteley M.S.
        • Lewis-Shiell C.
        • Bishop S.I.
        • et al.
        Pelvic vein embolisation of gonadal and internal iliac veins can be performed safely and with good technical results in an ambulatory vein clinic, under local anaesthetic alone - results from two years' experience.
        Phlebology. 2018; 33: 575-579
        • Basile A.
        • Failla G.
        • Gozzo C.
        Pelvic congestion syndrome.
        Semin Ultrasound CT MR. 2021; 42: 3-12
        • Scultetus A.H.
        • Villavicencio J.L.
        • Gillespie D.L.
        • et al.
        The pelvic venous syndromes: analysis of our experience with 57 patients.
        J Vasc Surg. 2002; 36: 881-888
        • Meissner M.H.
        • Khilnani N.M.
        • Labropoulos N.
        • et al.
        The symptoms-varices-pathophysiology classification of pelvic venous disorders: a report of the American vein & lymphatic society international working group on pelvic venous disorders.
        J Vasc Surg Venous Lymphat Disord. 2021; 9: 568-584
        • Dessole S.
        • Capobianco G.
        • Arru A.
        • et al.
        Postpartum ovarian vein thrombosis: an unpredictable event: two case reports and review of the literature.
        Arch Gynecol Obstet. 2003; 267: 242-246
        • Akinbiyi A.A.
        • Nguyen R.
        • Katz M.
        Postpartum ovarian vein thrombosis: two cases and review of literature.
        Case Rep Med. 2009; 2009101367
        • Ogiwara M.
        • Ozaki M.
        • Nishino Y.
        • et al.
        Fatal pulmonary thromboembolism caused by idiopathic ovarian vein thrombosis.
        Respirol Case Rep. 2021; 9e00795
        • Sinha D.
        • Yasmin H.
        • Samra J.S.
        Postpartum inferior vena cava and ovarian vein thrombosis: a case report and literature review.
        J Obstet Gynecol. 2005; 25: 312-313
        • Kominiarek M.A.
        • JU Hibbard
        Postpartum ovarian vein thrombosis: an update.
        Obstet Gynecol Surv. 2006; 61: 337-342
        • Christy J.
        • Jarugula D.
        • Kesari K.
        • et al.
        Idiopathic bilateral ovarian vein thrombosis.
        BMJ Case Rep. 2021; 14e238243
        • Kakkos S.K.
        • Gohel M.
        • Baekgaard N.
        • et al.
        European Society for Vascular Surgery (ESVS) 2021 Clinical practice guidelines on the management of venous thrombosis.
        Eur J Vasc Endovasc Surg. 2021; 61: 9-82