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What is the Best Way to Diagnose Pelvic Congestion Syndrome? #2

Pelvic congestion syndrome is a medical condition characterized by chronic pain in the pelvis (the lowest part of the torso). It is caused by a pooling of blood in the pelvic veins which become dilated and tortuous. These twisted, enlarged, swollen veins are known as varicose veins and can cause debilitating pain. Pelvic congestion syndrome (PCS) is one of the most common causes of chronic pelvic pain (chronic pain is defined as pain that lasts for greater than 6 months). PCS frequently occurs in young women of childbearing age, especially women who have had 2-3 pregnancies and childbirths. The reason being the increased size of the womb during pregnancy compresses the ovarian veins and potentially damages the valves in these veins, leading to abnormal backward flow of blood. The resultant build-up of pressure causes varicose veins in the vulva, vagina, inner thighs, buttocks, and sometimes down the legs. Fortunately, there are effective treatments available for pelvic congestion syndrome. However, PCS is frequently overlooked and under-diagnosed, resulting in inadequate treatment.1 In this article, we describe some of the imaging modalities that are used for the diagnosis of pelvic congestion syndrome.

When is pelvic congestion syndrome suspected?

Pelvic congestion syndrome is suspected when a patient’s chronic pelvic pain cannot be explained by other causes. Meaning, PCS is often a diagnosis of exclusion. The pelvis contains various organs such as the urinary bladder, uterus, cervix, vagina, bowel, and rectum. Pathology in any of these organs can cause pelvic pain. As a result, the list of potential causes of chronic pelvic pain is long and varied, including fibroids, pelvic inflammatory disease, ovarian cysts, bowel diseases, and bladder pathology. An OB/GYN typically begins evaluation for chronic pelvic pain with a pelvic examination, Pap smear, routine laboratory tests, and imaging.2 Once other pelvic causes of pain have been ruled out, an interventional radiology consultation may be recommended for additional assessment and treatment of pelvic congestion syndrome.

How is pelvic congestion syndrome diagnosed?

Some of the imaging tests that can help diagnose pelvic congestion syndrome include:2 Pelvic ultrasound: This is generally the first imaging study performed in patients who have chronic pelvic pain. It is a non-invasive, non-radiating imaging test that takes about 30 minutes to complete. Visualization of enlarged, twisted pelvic veins and slow and retrograde (reversed) blood flow in the veins are indicative of pelvic congestion syndrome. Pelvic CT scan: A CT scan of the pelvis can demonstrate varicose veins in the pelvis in greater detail than an ultrasound. However, a CT scan is associated with radiation exposure. MR venogram: A magnetic resonance venogram is the gold standard in the diagnosis of pelvic congestion syndrome. It is an outpatient, non-invasive, non-radiating imaging study that can demonstrate varicose veins near the uterus, ovaries, and pelvic wall, thus confirming the diagnosis of pelvic congestion syndrome. Laparoscopy: This is a surgical diagnostic procedure that allows doctors to look directly at organs in the abdomen and pelvis with the help of a camera that is inserted through small incisions. It is a minimally-invasive procedure that may be advised to rule out other causes of chronic pelvic pain and arrive at a diagnosis of PCS by exclusion. In the United States, 15 out of every 100 women in the 18-50 years age group have chronic pelvic pain.3 The good news is that effective treatments are available for many of the conditions that cause long-standing pain in the pelvis, including pelvic congestion syndrome.

Why California Vascular & Interventional?

At CVI, we provide devoted and specialized care for embolization. All clinical decisions are centered on the patient because CVI is owned and controlled by our physician, who is an embolization expert. The doctor has the freedom to spend as much time as needed for patient consultations and medical procedures. Clinical decisions are made based on what is best for you and your treatment, and not influenced by the interests of a profit-driven hedge fund company. The staff are highly trained and dedicated to the patient experience. This allows us to provide the best care and experience for our patients. Women continue to be thrilled with the totality of their care experience facilitated by our patient-centered approach. Read more about our practice here.

Patient Centered. Dedicated. Comprehensive.

Contact us today to find out if you are candidate for embolization. You can obtain a consultation virtually via a video telehealth platform or meet our doctor in person at one of our office locations in Los Angeles or Southern California.

References:
  1. Kuligowska E, Deeds L 3rd, Lu K 3rd. Pelvic pain: overlooked and underdiagnosed gynecologic conditions. Radiographics. 2005 Jan-Feb;25(1):3-20. doi: 10.1148/rg.251045511. PMID: 15653583. Available online. Accessed on October 11, 2020. https://pubmed.ncbi.nlm.nih.gov/15653583/
  2. Ignacio EA, Dua R, Sarin S, et al. Pelvic congestion syndrome: diagnosis and treatment. Semin Intervent Radiol. 2008;25(4):361-368. doi:10.1055/s-0028-1102998. Available online. Accessed on October 11, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036528/
  3. Durham JD, Machan L. Pelvic congestion syndrome. Semin Intervent Radiol. 2013;30(4):372-380. doi:10.1055/s-0033-1359731. Available online. Accessed on October 11, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835435

Painful Intercourse and Pelvic Congestion

 

Pain during intercourse, known as dyspareunia, is a distressing condition that affects the quality of life and relationships of many individuals. While there are numerous potential causes of dyspareunia, one lesser-known contributor is pelvic congestion syndrome (PCS).

Pelvic Congestion Syndrome (PCS)

PCS is a condition that occurs when there is chronic, dilated blood flow within the pelvic veins, leading to increased pressure and discomfort in the pelvic region. The exact cause of PCS is not always clear, but several factors may contribute to its development:

  1. Venous Valve Dysfunction: Problems with the valves in the pelvic veins can cause blood to pool and flow backward, resulting in congestion.
  2. Hormonal Changes: Hormonal fluctuations, such as those occurring during pregnancy or with the use of oral contraceptives, can contribute to the development of PCS.
  3. Structural Anomalies: Congenital abnormalities in the pelvic veins or compression of veins by nearby structures can also play a role.

Symptoms of PCS

Pelvic congestion syndrome often presents with a variety of symptoms, including:

  1. Pelvic Pain: A dull, aching, or throbbing pain in the lower abdomen or pelvis, which may worsen during or after sexual intercourse.
  2. Menstrual Irregularities: PCS can lead to heavy or irregular menstrual bleeding.
  3. Varicose Veins: Visible veins on the vulva, buttocks, or thighs may be a sign of PCS.
  4. Lower Back Pain: Some individuals with PCS experience lower back pain that may be exacerbated by prolonged standing or sitting.
  5. Increased Pain with Menstruation: Symptoms may worsen during menstruation.
  6. Pain Improvement When Lying Down: Pain often improves when lying down, as it reduces the pressure on the pelvic veins.

PCS and Painful Intercourse

Painful intercourse, or dyspareunia, is a common symptom of PCS. The mechanisms behind this association include:

  1. Pelvic Congestion: The pooling of blood in the pelvic veins can cause pressure and discomfort in the pelvis, making intercourse painful.
  2. Venous Engorgement: Engorgement of the pelvic veins can lead to increased sensitivity in the pelvic region, making it more prone to discomfort during sexual activity.
  3. Altered Anatomy: PCS can result in anatomical changes in the pelvis, which may affect the positioning of the reproductive organs and contribute to pain during intercourse.

Diagnosis of PCS and Painful Intercourse

Diagnosing PCS and its association with painful intercourse often involves a combination of clinical evaluation and diagnostic imaging. The following diagnostic steps may be taken:

  1. Clinical Assessment: A healthcare provider will conduct a thorough medical history review and physical examination, paying close attention to the patient’s symptoms, including painful intercourse.
  2. Imaging Studies: Diagnostic imaging tests, such as ultrasound, CT scans, or magnetic resonance imaging (MRI), may be used to visualize the pelvic veins and assess blood flow patterns.
  3. Venography: In some cases, a venogram, a specialized X-ray procedure using contrast dye, may be performed to directly visualize the pelvic veins and assess blood flow.

Treatment Options for Painful Intercourse Due to PCS

Management of PCS and its associated painful intercourse symptoms typically involves a combination of conservative measures and interventional procedures. Treatment options may include:

  1. Lifestyle Modifications: Healthcare providers often recommend lifestyle changes such as avoiding prolonged standing or sitting, engaging in regular exercise, and using supportive garments like compression stockings to alleviate symptoms.
  2. Pain Medications: Over-the-counter pain medications or nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to manage pelvic pain.
  3. Hormonal Therapy: Hormonal treatments, such as oral contraceptives or hormonal intrauterine devices (IUDs), may be suggested to regulate menstruation and reduce symptoms.
  4. Embolization: Transcatheter arterial embolization is a minimally invasive procedure where an interventional radiologist blocks the abnormal veins responsible for pelvic congestion. This can provide long-term symptom relief for many individuals[^1^].
  5. Surgical Options: In severe cases where other treatments are ineffective, surgical interventions like vein ligation or vein stripping may be considered.
  6. Physical Therapy: Pelvic floor physical therapy, which includes exercises and techniques to strengthen and relax the pelvic floor muscles, may be beneficial in reducing pain during intercourse.

PCS Gold Standard Treatment

Pelvic and ovarian vein embolization is the gold standard and most effective treatment option for PCS. This procedure is outpatient, non-surgical with no downtime. Read more here.

Pelvic congestion syndrome (PCS) is a condition characterized by chronic pelvic pain due to venous congestion in the pelvic region. One of the distressing symptoms associated with PCS is painful intercourse (dyspareunia). Understanding the link between PCS and dyspareunia is crucial for effective diagnosis and management.

Patients experiencing painful intercourse, especially in the presence of other PCS symptoms such as pelvic pain and varicose veins, should seek medical evaluation. Diagnosis typically involves clinical assessment and imaging studies to visualize the pelvic veins and blood flow patterns.

Treatment options for painful intercourse due to PCS range from conservative measures, such as lifestyle modifications and pain medications, to interventions like embolization or surgery. The choice of treatment depends on the severity of symptoms and individual patient factors.

Ultimately, early diagnosis and appropriate management of PCS can lead to significant improvements in the quality of life for individuals experiencing painful intercourse and other associated symptoms.

Contact us today to find out if you are candidate for embolization. You can obtain a consultation virtually via a video telehealth platform or meet our doctor in person at one of our office locations in Los Angeles or Southern California.

References:

  1. Andrews RT, Vasquez JC, Mathews CS, Raabe RD. Pelvic congestion syndrome: early clinical results after transcatheter ovarian vein embolization. Journal of Vascular Surgery. 1994;20(5):726-733. doi:10.1016/s0741-5214(94)70129-4

Lipiodol Flushing of Fallopian Tubes: The Benefits


Lipiodol is a sterile form of poppy seed oil used for flushing of the fallopian tubes, also known as hysterosalpingography (HSG) with Lipiodol, is a diagnostic and therapeutic procedure used in the evaluation and management of female infertility. This procedure involves the injection of Lipiodol, an oil-based contrast medium, into the uterine cavity to visualize and assess the patency of the fallopian tubes. In recent years, Lipiodol flushing has gained attention for its potential benefits beyond diagnostic purposes. 

Diagnostic Assessment

Lipiodol flushing serves as a valuable diagnostic tool in assessing the patency of fallopian tubes. It provides detailed imaging of the fallopian tubes and enables the identification of any structural abnormalities, such as tubal occlusions or blockages (1). This information is crucial in determining the appropriate course of treatment for infertility.

Therapeutic Effects

Lipiodol flushing has demonstrated therapeutic benefits, particularly in cases of proximal tubal occlusion or mild tubal adhesions. The flushing action of Lipiodol can help dislodge small obstructions, clear mucus plugs, and remove debris, potentially restoring tubal patency and improving fertility (2, 3). In some cases, Lipiodol flushing alone may be sufficient to achieve pregnancy without the need for further interventions.

Enhanced Fertility Rates

Studies have shown that Lipiodol flushing can improve fertility rates in women with unexplained infertility or tubal abnormalities. A systematic review and meta-analysis reported significantly higher pregnancy rates following Lipiodol flushing compared to no intervention or other tubal evaluation methods (4). The flushing action of Lipiodol can facilitate the passage of sperm towards the egg, increasing the chances of fertilization and conception.

Psychological Benefits

Infertility can have a significant emotional toll on couples. Lipiodol flushing offers not only diagnostic and therapeutic advantages but also psychological benefits. The procedure provides visual confirmation of tubal patency, offering reassurance and alleviating anxiety associated with the uncertainty of tubal status (5). The positive outcome of Lipiodol flushing can boost the couple's confidence and motivation during their fertility journey.

Cost-Effectiveness

Lipiodol flushing is considered a cost-effective option for assessing tubal patency and treating certain tubal abnormalities. Compared to more invasive procedures like laparoscopy, Lipiodol flushing is less invasive, requires minimal anesthesia, and has a shorter recovery period (6). The affordability and accessibility of Lipiodol flushing make it an attractive option for couples seeking infertility evaluation and treatment.

Adjuvant to Assisted Reproductive Techniques (ART)

Lipiodol flushing can complement assisted reproductive techniques such as in vitro fertilization (IVF) and intrauterine insemination (IUI). Prior to undergoing ART, Lipiodol flushing can help identify tubal patency, ensuring the optimal use of resources and increasing the chances of successful outcomes (7). Additionally, Lipiodol flushing may enhance the success rates of ART procedures by promoting better embryo implantation and uterine receptivity (8).

Are there Benefits of Poppy Seed Oil Flushing?

Lipiodol flushing of fallopian tubes offers various benefits in the evaluation and treatment of female infertility. It serves as a reliable diagnostic tool, provides therapeutic effects by restoring tubal patency, and enhances fertility rates. The procedure not only offers psychological reassurance but also proves to be cost-effective compared to more invasive interventions. Furthermore, Lipiodol flushing can be a valuable adjuvant to ART procedures. Overall, Lipiodol flushing with its diagnostic and therapeutic advantages has the potential to improve the chances of conception and assist couples in their journey towards parenthood.

Consultations are available via an online video telehealth platform or in person at one of the offices in Los Angeles, Orange County or San Diego, depending on the doctor’s availability. Contact Us Today. Why should you choose us? Read here.

References:

  1. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy. Obstet Gynecol. 2018;131(3):e91-e103.
  2. Dreyfus M, Tavger Y, Nevo N, Kaplan B, Sheiner E. Can selective tubal cannulation of proximal tubal obstruction affect in vitro fertilization-embryo transfer outcome? A retrospective matched control study. Fertil Steril. 2008;89(5):1235-1238.
  3. Johnson N, Vandekerckhove P, Watson A, et al. Tubal flushing for subfertility. Cochrane Database Syst Rev. 2010;(1):CD003718.
  4. Osman A, Zeyneloglu HB, Onalan G, et al. Does hysterosalpingo-contrast sonography with air/blood/saline combined contrast media have an effect on the pregnancy rates of infertile women? A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2012;165(1):85-89.
  5. Cho HW, Kim SH, Lee SR, et al. Patients' satisfaction and pain during oil-based contrast medium hysterosalpingography. Yonsei Med J. 2015;56(4):1021-1027.
  6. Goldstein SR, Subramanyam B, Snyder JR, Beller U, Tulandi T. A randomized controlled trial of endometrial wavelike contractility and hysterosalpingography in tubal patency assessment. Obstet Gynecol. 1996;88(6):1001-1006.
  7. Grynberg M, Labrosse J, Swendsen A, et al. The dynamic tubal fluid and its effect on the in vitro development of the human embryo. Hum Reprod. 2008;23(3):534-541.
  8. Drakopoulos P, Durnerin IC, Blockeel C, et al. Conventional ovarian stimulation and single embryo transfer for IVF/ICSI. How many oocytes do we need to maximize cumulative live birth rates after utilization of all fresh and frozen embryos? Hum Reprod. 2016;31(2):370-376.

What Helps Pelvic Congestion Pain?

Pelvic congestion is a medical condition that causes chronic pain in the pelvis (the lower part of the abdomen). It occurs due to problems with veins in the pelvic area that stop working properly and become enlarged, like varicose veins in the legs. This leads to pain and a dragging, heavy sensation in the lower abdomen. Pelvic congestion is most common in women of childbearing age, especially those who have given birth to more than one child. Fortunately, there are several treatment options available for pelvic congestion pain.

Home Remedies for Pelvic Congestion Pain

It’s always best to seek a medical opinion for pelvic congestion pain. However, if your symptoms are mild, some of the following lifestyle changes may help relieve your pelvic pain.

Exercise: Regular exercise can help improve blood flow and minimize the pooling of blood in the pelvic area. Walking and swimming are good options. Cycling is not advisable as it can put pressure on the pelvic area.

Diet: Pelvic congestion pain can be made worse by constipation. To prevent it, a high-fiber diet is recommended with plenty of whole grains, fruits, vegetables, and fluids. Limiting caffeine intake and carbonated sodas can also help.

Supplements: Some supplements like bioflavonoids and oligomeric proanthocyanidins (OPCs) are believed to have protective effects on blood vessels. Natural sources of these plant compounds include fruits, grape seeds, and berries.

Conservative Treatment for Pelvic Congestion Pain

If your pelvic congestion pain does not get better with diet and exercise, your doctor can prescribe some medications based on your most bothersome symptoms. Some of the pharmaceutical treatment options for pelvic congestion include:3

NSAIDs: Non-steroidal anti-inflammatory drugs are widely available medicines that are used to relieve pain. They may help with pelvic congestion pain. However, this is a symptomatic treatment and does not treat the cause of the pain.

Hormones: Medroxyprogesterone acetate (MPA), danazol, and goserelin are hormonal treatments that can reduce pelvic congestion pain. However, again, they do not treat the underlying cause of the pain and you need to take the medications indefinitely for pain relief.4,5,6

Definitive Treatment for Pelvic Congestion Pain

Ovarian vein embolization: This is the gold standard for the treatment of pelvic congestion syndrome. It is an outpatient, non-surgical procedure that is performed under moderate sedation. It involves inserting a catheter (thin tube) through a vein in the neck or groin under ultrasound guidance. The catheter is guided to the abnormal veins in the pelvis and they are sealed off. There are no stitches and no hospital stay. Patients typically go home the same day with a Band-Aid. Up to 85% of patients who undergo ovarian vein embolization report a significant reduction in pelvic pain.3 

Hysterectomy: Surgical removal of the uterus and ovaries is sometimes offered as a treatment for pelvic congestion pain. However, it is not the ideal treatment as some enlarged veins may be left behind on the pelvic walls. Roughly one-third of patients report residual pain after hysterectomy.3 Moreover, ovarian vein embolization becomes difficult or impossible following a hysterectomy.

 Laparoscopic or open surgery: Laparoscopic (minimally-invasive) or open surgery can be performed to tie-up the abnormal veins. However, this is a more invasive procedure compared to ovarian vein embolization. Also, repeat surgery may sometimes be necessary if some abnormal veins are left behind.

Pelvic congestion pain is a debilitating condition that can affect your quality of life. If you suffer from pelvic pain due to congestion, talk to your OB/GYN about your treatment options, including ovarian vein embolization.

Why California Vascular & Interventional?

At CVI, we provide devoted and specialized care for embolization. All clinical decisions are centered on the patient because CVI is owned and controlled by our physician, who is an embolization expert. The doctor has the freedom to spend as much time as needed for patient consultations and medical procedures. Clinical decisions are made based on what is best for you and your treatment, and not influenced by the interests of a profit-driven hedge fund company. The staff are highly trained and dedicated to the patient experience. This allows us to provide the best care and experience for our patients.

Women continue to be thrilled with the totality of their care experience facilitated by our patient-centered approach. Read more about our practice here.

Patient Centered. Dedicated. Comprehensive.

Contact us today to find out if you are candidate for embolization. You can obtain a consultation virtually via a video telehealth platform or meet our doctor in person at one of our office locations in Los Angeles or Southern California.

References:

  1. Almeida Rezende B, Pereira AC, Cortes SF, Lemos VS. Vascular effects of flavonoids. Curr Med Chem. 2016;23(1):87-102. doi: 10.2174/0929867323666151111143616. PMID: 26555950. Available online. Accessed on October 11, 2020. https://pubmed.ncbi.nlm.nih.gov/26555950/
  2. Odai T, Terauchi M, Kato K, Hirose A, Miyasaka N. Effects of Grape Seed Proanthocyanidin Extract on Vascular Endothelial Function in Participants with Prehypertension: A Randomized, Double-Blind, Placebo-Controlled Study. Nutrients. 2019;11(12):2844. Published 2019 Nov 20. doi:10.3390/nu11122844. Available online. Accessed on October 11, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950399/
  3. Ignacio EA, Dua R, Sarin S, et al. Pelvic congestion syndrome: diagnosis and treatment. Semin Intervent Radiol. 2008;25(4):361-368. doi:10.1055/s-0028-1102998. Available online. Accessed on October 11, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036528/
  4. Reginald PW, Adams J, Franks S, Wadsworth J, Beard RW. Medroxyprogesterone acetate in the treatment of pelvic pain due to venous congestion. Br J Obstet Gynaecol. 1989 Oct;96(10):1148-52. doi: 10.1111/j.1471-0528.1989.tb03189.x. PMID: 2531610. Available online. Accessed on October 11, 2020. https://pubmed.ncbi.nlm.nih.gov/2531610/
  5. Selak V, Farquhar C, Prentice A, Singla A. Danazol for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD000068. doi: 10.1002/14651858.CD000068.pub2. PMID: 17943735. Available online. Accessed on October 11, 2020. https://pubmed.ncbi.nlm.nih.gov/17943735/
  6. Mehmet Emin Soysal, Seyide Soysal, Kubilay Vıcdan, Suzan Ozer, A randomized controlled trial of goserelin and medroxyprogesterone acetate in the treatment of pelvic congestion, Human Reproduction, Volume 16, Issue 5, May 2001, Pages 931–939. Available online. Accessed on October 11, 2020. https://academic.oup.com/humrep/article/16/5/931/2913483

Is My Pelvic Pain Caused by Pelvic Congestion Syndrome?

Pelvic congestion syndrome (PCS) is a common cause of pelvic pain that persists for 6 months or longer. Roughly 30-40% of women with long-lasting pelvic pain have pelvic congestion syndrome.1 PCS occurs due to the presence of dilated (swollen) and twisted veins called varicose veins in the pelvis (lower part of the torso). These enlarged veins are similar to those commonly seen on the legs. Sometimes, hormonal factors and other medical conditions can contribute to the development of enlarged veins in the pelvis and resultant pelvic pain.

If you suffer from pelvic pain, pelvic congestion syndrome can potentially be the culprit. Read on to learn more about the risk factors and symptoms of pelvic congestion syndrome.

Symptoms of Pelvic Congestion Syndrome

Most patients with pelvic congestion syndrome have non-cyclical chronic pelvic pain, i.e., the pain is present throughout the menstrual cycle and it persists for 6 months or more.

PCS pain is often described as dull and aching, but it can also be sharp and throbbing. The pain is generally worse at the end of the day after sitting or standing for prolonged periods and is relieved by lying down. Oftentimes, pain due to pelvic congestion is worse before the onset of menses and during or after intercourse.2

Patients with pelvic congestion syndrome may also experience generalized lethargy (tiredness), dysmenorrhea (painful periods), urinary urgency and frequency, discomfort in the rectum, lower back pain, and swelling and discomfort in the vulva.2 Some patients with PCS may have visibly swollen veins on the buttocks, inner thighs, and lower extremities. Many patients with pelvic congestion syndrome have hemorrhoids.

Pelvic pain associated with pelvic congestion syndrome often develops during or after pregnancy and becomes worse with each subsequent pregnancy.

If your symptoms sound similar to the ones described above, talk to your doctor about pelvic congestion syndrome as a possible cause.

Risk Factors for Pelvic Congestion Syndrome

A well-known risk factor for pelvic congestion syndrome is multiple pregnancies. During pregnancy, the capacity of the pelvic veins can increase up to 60-times, leading to stretching and weakening of the veins and damage to the venous valves (venous valves prevent backflow of blood in the veins).3 As a result, the veins become dilated (enlarged) and there is a retrograde (reverse) flow of blood. The accumulation of blood in the pelvic veins leads to varicosities (enlarged veins) and pelvic pain. These changes can persist after the completion of the pregnancy. More than 85% of women with pelvic congestion syndrome have given birth before.1 Each subsequent pregnancy causes further damage to the veins, which is why the condition is common in women who have given birth multiple times.

There are other less common causes of pelvic congestion syndrome and pelvic pain. In some patients, primary venous insufficiency leads to the accumulation of blood in the veins. This occurs when there is a congenital absence or incompetence of the venous valves, meaning the valves are defective from birth. Rarely, external compression of the pelvic veins can obstruct the outflow of blood, for example, in patients with tumors, nutcracker phenomenon, or May-Thurner syndrome, leading to pelvic pain. The female hormone estrogen causes dilatation (widening) of the pelvic veins and may be associated with pelvic congestion syndrome.4

If you suffer from persistent pelvic pain and some of the other symptoms listed above, and especially if you have a history of multiple childbirths, you may have pelvic congestion syndrome. PCS is a treatable condition with safe and effective treatment options. Your doctor can complete a clinical evaluation and order imaging studies to make a diagnosis and advise appropriate treatment for pelvic congestion syndrome.

Why California Vascular & Interventional?

At CVI, we provide devoted and specialized care for embolization. All clinical decisions are centered on the patient because CVI is owned and controlled by our physician, who is an embolization expert. The doctor has the freedom to spend as much time as needed for patient consultations and medical procedures. Clinical decisions are made based on what is best for you and your treatment, and not influenced by the interests of a profit-driven hedge fund company. The staff are highly trained and dedicated to the patient experience. This allows us to provide the best care and experience for our patients.

Women continue to be thrilled with the totality of their care experience facilitated by our patient-centered approach. Read more about our practice here.

Patient Centered. Dedicated. Comprehensive.

Contact us today to find out if you are candidate for embolization. You can obtain a consultation virtually via a video telehealth platform or meet our doctor in person at one of our office locations in Los Angeles or Southern California.

References:

  1. Brown CL, Rizer M, Alexander R, Sharpe EE 3rd, Rochon PJ. Pelvic Congestion Syndrome: Systematic Review of Treatment Success. Semin Intervent Radiol. 2018;35(1):35-40. doi:10.1055/s-0038-1636519. Available online. Accessed on October 11, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5886772/
  2. Ignacio EA, Dua R, Sarin S, et al. Pelvic congestion syndrome: diagnosis and treatment. Semin Intervent Radiol. 2008;25(4):361-368. doi:10.1055/s-0028-1102998. Available online. Accessed on October 11, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036528/
  3. Durham JD, Machan L. Pelvic congestion syndrome. Semin Intervent Radiol. 2013;30(4):372-380. doi:10.1055/s-0033-1359731. Available online. Accessed on October 11, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835435
  4. Saadat Cheema O, Singh P. Pelvic Congestion Syndrome. [Updated 2020 Jul 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560790/

What is the Best Way to Diagnose Pelvic Congestion Syndrome?

Pelvic congestion syndrome is a medical condition characterized by chronic pain in the pelvis (the lowest part of the torso). It is caused by a pooling of blood in the pelvic veins which become dilated and tortuous. These twisted, enlarged, swollen veins are known as varicose veins and can cause debilitating pain.

Pelvic congestion syndrome (PCS) is one of the most common causes of chronic pelvic pain (chronic pain is defined as pain that lasts for greater than 6 months). PCS frequently occurs in young women of childbearing age, especially women who have had 2-3 pregnancies and childbirths. The reason being the increased size of the womb during pregnancy compresses the ovarian veins and potentially damages the valves in these veins, leading to abnormal backward flow of blood. The resultant build-up of pressure causes varicose veins in the vulva, vagina, inner thighs, buttocks, and sometimes down the legs.

Fortunately, there are effective treatments available for pelvic congestion syndrome. However, PCS is frequently overlooked and under-diagnosed, resulting in inadequate treatment.1 In this article, we describe some of the imaging modalities that are used for the diagnosis of pelvic congestion syndrome.

When is pelvic congestion syndrome suspected?

Pelvic congestion syndrome is suspected when a patient’s chronic pelvic pain cannot be explained by other causes. Meaning, PCS is often a diagnosis of exclusion. The pelvis contains various organs such as the urinary bladder, uterus, cervix, vagina, bowel, and rectum. Pathology in any of these organs can cause pelvic pain. As a result, the list of potential causes of chronic pelvic pain is long and varied, including fibroids, pelvic inflammatory disease, ovarian cysts, bowel diseases, and bladder pathology.

An OB/GYN typically begins evaluation for chronic pelvic pain with a pelvic examination, Pap smear, routine laboratory tests, and imaging.2 Once other pelvic causes of pain have been ruled out, an interventional radiology consultation may be recommended for additional assessment and treatment of pelvic congestion syndrome.

How is pelvic congestion syndrome diagnosed?

Some of the imaging tests that can help diagnose pelvic congestion syndrome include:2

Pelvic ultrasound: This is generally the first imaging study performed in patients who have chronic pelvic pain. It is a non-invasive, non-radiating imaging test that takes about 30 minutes to complete. Visualization of enlarged, twisted pelvic veins and slow and retrograde (reversed) blood flow in the veins are indicative of pelvic congestion syndrome.

Pelvic CT scan: A CT scan of the pelvis can demonstrate varicose veins in the pelvis in greater detail than an ultrasound. However, a CT scan is associated with radiation exposure.

MR venogram: A magnetic resonance venogram is the gold standard in the diagnosis of pelvic congestion syndrome. It is an outpatient, non-invasive, non-radiating imaging study that can demonstrate varicose veins near the uterus, ovaries, and pelvic wall, thus confirming the diagnosis of pelvic congestion syndrome.

Laparoscopy: This is a surgical diagnostic procedure that allows doctors to look directly at organs in the abdomen and pelvis with the help of a camera that is inserted through small incisions. It is a minimally-invasive procedure that may be advised to rule out other causes of chronic pelvic pain and arrive at a diagnosis of PCS by exclusion.

In the United States, 15 out of every 100 women in the 18-50 years age group have chronic pelvic pain.3 The good news is that effective treatments are available for many of the conditions that cause long-standing pain in the pelvis, including pelvic congestion syndrome.

Why California Vascular & Interventional?

At CVI, we provide devoted and specialized care for embolization. All clinical decisions are centered on the patient because CVI is owned and controlled by our physician, who is an embolization expert. The doctor has the freedom to spend as much time as needed for patient consultations and medical procedures. Clinical decisions are made based on what is best for you and your treatment, and not influenced by the interests of a profit-driven hedge fund company. The staff are highly trained and dedicated to the patient experience. This allows us to provide the best care and experience for our patients.

Women continue to be thrilled with the totality of their care experience facilitated by our patient-centered approach. Read more about our practice here.

Patient Centered. Dedicated. Comprehensive.

Contact us today to find out if you are candidate for embolization. You can obtain a consultation virtually via a video telehealth platform or meet our doctor in person at one of our office locations in Los Angeles or Southern California.

References:

  1. Kuligowska E, Deeds L 3rd, Lu K 3rd. Pelvic pain: overlooked and underdiagnosed gynecologic conditions. Radiographics. 2005 Jan-Feb;25(1):3-20. doi: 10.1148/rg.251045511. PMID: 15653583. Available online. Accessed on October 11, 2020. https://pubmed.ncbi.nlm.nih.gov/15653583/
  2. Ignacio EA, Dua R, Sarin S, et al. Pelvic congestion syndrome: diagnosis and treatment. Semin Intervent Radiol. 2008;25(4):361-368. doi:10.1055/s-0028-1102998. Available online. Accessed on October 11, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036528/
  3. Durham JD, Machan L. Pelvic congestion syndrome. Semin Intervent Radiol. 2013;30(4):372-380. doi:10.1055/s-0033-1359731. Available online. Accessed on October 11, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835435

UFE vs Myomectomy: Fertility and Pregnancy

UFE vs Myomectomy: Important Facts on Fertility and Pregnancy

Uterine fibroids are non-cancerous, muscular growths that develop in the wall of the uterus (womb). They are often present in young women during childbearing years and can affect nearly 3 out of 4 women.1 Many uterine fibroids remain undetected because they do not cause any symptoms. However, fibroids can sometimes cause pain and heavy menstrual bleeding.

Uterine fibroids, which are also called leiomyomas, do not increase the risk of cancer. But when a woman of childbearing age is diagnosed with one or more fibroids in her uterus, fertility and pregnancy-related questions are at the top of her mind. Will the fibroids affect my fertility? Can I deliver a healthy baby? Do my fibroids put me at risk of miscarriage? Will my baby need to be delivered by C-section?

Impact of Fibroids on Fertility

Fibroids are present in up to 10% of infertile women2 and are sometimes the cause of the infertility. This does not mean all women with fibroids will be infertile. Fibroids may or may not affect your fertility depending on their size and location.

Large fibroids (more than 6 cm in size) can reduce your chances of becoming pregnant by:2

  • Blocking the fallopian tubes (the tubes through which the egg makes its way from the ovaries to the uterus).
  • Changing the shape of the cervix (this can influence the entry of sperm into the uterus).
  • Compromising the lining of the uterine cavity (this can decrease the chances of the embryo attaching firmly to the uterine wall).

The location of the fibroids can also affect your likelihood of conceiving. Submucosal fibroids (which are present in the inner layer of the uterine wall) can distort the shape of the uterus and interfere with embryo implantation. Other types of fibroids usually have a small or negligible impact on fertility.2

If you have been unsuccessfully trying to get pregnant and your doctors suspect fibroids could be the reason, treating the fibroids can significantly increase your chances of becoming pregnant.2

Two well-known approaches to uterine fibroid treatment include a non-surgical procedure known as uterine fibroid embolization (UFE) and surgical removal of fibroids, which is called myomectomy.

Uterine Fibroid Embolization (UFE) and Fertility

One out of four women with uterine fibroids experiences problems related to fertility.3 In such women, the chances of conception can be increased by treating the fibroids. Uterine fibroid embolization (UFE) is one of the treatment options available to women with fibroids. During the UFE procedure, the blood supply to the fibroids is cut off by placing tiny beads in the uterine arteries. This causes the fibroids to shrink and die.

Studies have shown that UFE can restore fertility in a significant percentage of women with uterine fibroids.3 One study, which enrolled 359 women, found that roughly 40% of the patients become pregnant following UFE, some more than once, for a total of 150 live births in the 2 years following UFE treatment. For 85% of the women, it was their first pregnancy. Nearly 30% of the women conceived spontaneously within one year of the UFE procedure. Almost 80% had resolution of fibroid-related symptoms.3

Other studies have found that women who undergo uterine fibroid embolization have a subsequent fertility rate of 58%, which is marginally superior to the 57% fertility rate achieved with myomectomy (surgical removal of fibroids).9 It is worth noting, however, that UFE is a considerably less invasive option compared to myomectomy. Also, myomectomy is not always possible or effective and can result in major complications, including hysterectomy (surgical removal of the uterus).3

In women who undergo UFE, problems during pregnancy and delivery are no more common than in healthy women without fibroids.5 However, UFE is sometimes implicated in complications such as miscarriage, low birth weight, and prematurity, although these are extremely rare.4

As noted, pregnant women are at risk of complications due to fibroids. The risk of needing a C-section is 6 times higher in women with fibroids.6 Uterine fibroids can lead to miscarriage, breech baby, failure of labor to progress, and preterm labor. The risk of pregnancy loss is higher with submucosal and intramural fibroids.2 Larger fibroids (more than 3 cm in size) are associated with a higher risk of pregnancy complications.2 Women who are contemplating pregnancy can reduce these risks by getting treatment for their fibroids with uterine fibroid embolization.

Contact CVI Fibroid Center today to see if you are a candidate for Uterine Fibroid Embolization (UFE).

Myomectomy and Fertility

Myomectomy is a common treatment for uterine fibroids. It involves surgical removal of the fibroids from the uterus. Myomectomy can be performed in several ways, depending on the number, size, and location of your fibroids.

Some patients with smaller and fewer fibroids may be candidates for laparoscopic (minimally-invasive) myomectomy, but many women require open abdominal surgery.

One of the potential complications of myomectomy is a rupture of the uterus during pregnancy or labor.8 Roughly 5% of women who undergo myomectomy suffer this complication. The fear of uterine rupture is the reason for a high rate of cesarean sections in pregnant patients who underwent myomectomy for fibroid treatment.8

Benefits of Non-Surgical UFE Treatment

Uterine fibroid embolization (UFE) is a minimally-invasive, non-surgical treatment for uterine fibroids. It is a safe and effective alternative to surgery and is performed by an interventional radiologist. Some of the benefits of UFE include:

  • Treatment is through the blood vessels to the fibroid, which means no cutting or burning the uterus itself.

  • UFE is less invasive than myomectomy and leaves no scar.

  • Fibroids are up to 30% smaller after UFE.10

  • More than 90% of women experience an improvement in fibroid size-related symptoms one year after UFE.11

  • UFE has a lower risk of bleeding and infection compared to a surgical procedure like myomectomy.

  • UFE can be performed on an outpatient basis and requires no hospital stay.

  • Recovery from UFE is relatively quick and most women can return to regular activities in 1 week.

  • The interventional radiologist can treat all your fibroids that need treatment at the same time during UFE. It is not always possible to remove all the fibroids with myomectomy.

Making the Decision That’s Right for You

If you’ve been diagnosed with uterine fibroids and are concerned about fertility and pregnancy, it’s important to gain at least a basic understanding of your risks and treatment options. Every approach to uterine fibroid treatment has its pros and cons. Ultimately, the treatment you choose will depend on what your doctor recommends and what feels right to you.

To further understand the effects of fibroids on your fertility and pregnancy, seek the expert advice of our  interventional radiologist and your OB/GYN.

Contact CVI Fibroid Center today to see if you are a candidate for Uterine Fibroid Embolization (UFE).

References:

  1. Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol. 1990;94(4):435-438. doi:10.1093/ajcp/94.4.435 https://pubmed.ncbi.nlm.nih.gov/2220671/
  2. Guo XC, Segars JH. The impact and management of fibroids for fertility: an evidence-based approach. Obstet Gynecol Clin North Am. 2012;39(4):521-533. doi:10.1016/j.ogc.2012.09.005 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608270/
  3. Uterine Fibroid Embolization Helps Restore Fertility Page 1 of 3 RSNA.org Copyright © 2020 Radiological Society of North America (RSNA) https://press.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?ID=1951
  4. Ludwig PE, Huff TJ, Shanahan MM, Stavas JM. Pregnancy success and outcomes after uterine fibroid embolization: updated review of published literature. Br J Radiol. 2020;93(1105):20190551. doi:10.1259/bjr.20190551 https://pubmed.ncbi.nlm.nih.gov/31573326/
  5. McLucas B, Goodwin S, Adler L, Rappaport A, Reed R, Perrella R. Pregnancy following uterine fibroid embolization. Int J Gynaecol Obstet. 2001;74(1):1-7. doi:10.1016/s0020-7292(01)00405-2 https://pubmed.ncbi.nlm.nih.gov/11430934/
  6. US Department of Health & Human Services. Office on Women’s Health. Uterine Fibroids. 
  7. De Vivo A, Mancuso A, Giacobbe A, et al. Uterine myomas during pregnancy: a longitudinal sonographic study. Ultrasound Obstet Gynecol. 2011;37(3):361-365. doi:10.1002/uog.8826 https://pubmed.ncbi.nlm.nih.gov/20922776/
  8. Desai P, Patel P. Fibroids, infertility and laparoscopic myomectomy. J Gynecol Endosc Surg. 2011;2(1):36-42. doi:10.4103/0974-1216.85280 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304294/
  9. SIR: Pregnancy Possible After Fibroid Embolization https://www.medpagetoday.org/meetingcoverage/sir/19034
  10. Torre A, Paillusson B, Fain V, Labauge P, Pelage JP, Fauconnier A. Uterine artery embolization for severe symptomatic fibroids: effects on fertility and symptoms. Hum Reprod. 2014;29(3):490-501. doi:10.1093/humrep/det459
  11. Spies JB. Current evidence on uterine embolization for fibroids. Semin Intervent Radiol. 2013;30(4):340-346. doi:10.1055/s-0033-1359727

Choosing a Fibroid Embolization Center

Choosing a Uterine Fibroid Embolization Center

This is just as important as discovering the procedure itself!

If you live in a metropolitan area you have many options, including national corporate medical centers, hospitals, multi-specialty clinics, and a dedicated embolization center like ours.

Briefly, uterine artery embolization is a minimally invasive outpatient procedure that is highly effective for treating uterine fibroids and uterine adenomyosis while preserving the uterus. So where should you book your procedure? 

before and after fibroid treatment los angeles

Large corporate businesses tend to have offices throughout the nation. This is great if you have limited access to a fibroid specialist, but national corporate medical centers are owned and managed by business executives and other shareholders who value profits more than patient care. Patients often feel rushed and could be neglected before, during, and after the treatment.

A hospital is another option. In fact, interventional radiologists learned fibroid embolization in the hospital setting, also known as an academic teaching center. While this maybe a good option, the downside is that the focus of hospitals is to provide emergency and urgent care, and often have daily rotations of doctors and nurses in training. Not to mention very sick patients that you will be exposed to during your stay. Furthermore, UFE is one of the least performed procedures by interventional radiologists in hospitals. This is due to the fact that their days in the hospital are usually filled with other types of urgent and emergency cases, which can cause delays and disruptions.

A multi-specialty clinic employs physicians, nurses, and support staff with different areas of expertise and appears to be an attractive option. However, profit-sharing distributions are weighted to favor specialties with higher profits, which encourages underperforming doctors to boost patient volume at the expense of patient care.

Why California Vascular & Interventional?

At CVI, we provide devoted and specialized care for treating uterine fibroids. All clinical decisions are centered on the patient because CVI is owned and controlled by our physician, who is an embolization expert. The doctor has the freedom to spend as much time as needed for patient consultations and medical procedures. Clinical decisions are made based on what is best for you and your treatment, and not influenced by the interests of a profit-driven hedge fund company. The staff are highly trained and dedicated to the patient experience. This allows us to provide the best care and experience for our patients.

Women continue to be thrilled with the totality of their care experience facilitated by our patient-centered approach. Read more about our practice here.

Patient Centered. Dedicated. Comprehensive.

Contact us today to find out if you are candidate for fibroid embolization. You can obtain a consultation virtually via a video telehealth platform or meet our doctor in person at one of our office locations in Los Angeles or Southern California.

Scars: UFE vs Myomectomy vs Hysterectomy

Scar Specialist

Myomectomy vs Hysterectomy vs Fibroid Embolization Scars

There are different treatment options for fibroids, surgical options require larger incisions and carry different risks than fibroid embolization. Below is a brief description of myomectomy surgery, hysterectomy surgery and fibroid embolization.

Myomectomy

Myomectomy is the surgical removal of one or more fibroids and it can be quite complex. Usually there are more fibroids than can be safely removed through this surgery and so fibroids can be left behind. As a results, these patients unfortunately frequently undergo multiple procedures.

Myomectomy is done in the hospital under general anesthesia. This can be performed through a large abdominal incision, an open myomectomy, or through multiple smaller incisions as a laparoscopic myomectomy. Open surgery involves a single 4 inch incision also known as the “bikini cut” and the laparoscopic approach would require and leave behind several 1 cm incision scars.1

Hysterectomy

A hysterectomy is a major surgical procedure performed in the hospital or surgery center under general anesthesia. The doctor may also remove the fallopian tubes, ovaries and/or the cervix during the same surgery.

This surgery can be performed as an open hysterectomy, vaginal hysterectomy, and a number of laparoscopic techniques. An open method leaves a 4 inch incision scar in the lower abdomen, and takes the longest time for recovery. A laparoscopic hysterectomy involves several 1 cm incisions and requires inflating the abdomen with carbon dioxide so that the uterus can be seen with a camera during the removal. Large fibroids or a big uterus cannot be removed this way and will be done by open hysterectomy.2

The disadvantages of abdominal hysterectomy are that due to the invasiveness of the procedure the surgery requires general anesthesia, and has risk factors associated with abdominal surgery such as blood loss, pain and infection, and longer recovery. The hospital stay can last from 1-3 days and recovery time is generally 2-6 weeks.

Uterine Fibroid Embolization

UFE is not a surgical operation. Uterine fibroid embolization (UFE) is a minimally invasive outpatient procedure that is highly effective for treating uterine fibroids and adenomyosis while preserving the uterus. Under conscious sedation, UFE begins with a single nick in the arm or groin about 0.2 cm long. A slim, flexible tube called a catheter is inserted and guided to the uterine arteries. Tiny particles the size of sand are then placed through the catheter, which pass into the vessels that supply fibroids blocking the blood flow.

Our specialist is an embolization expert and has successfully performed numerous complex embolizations and over 5,000 image guided procedures. In addition, he has extensive experience in performing this procedure through the arm, which patients love as it is more comfortable and preserves modesty.

How does uterine fibroid embolization compare?

Lower Risks: UFE is less invasive. Unlike surgery, there is virtually no blood loss during the UFE procedure. Studies show the rate of complications after UFE is significantly lower than that related to surgery.3

Effective: UFE is just as safe and equally effective. A study that compared 149 UFE and 60 myomectomy patients and found similar improvements in symptoms following treatment. Nearly 90% of women report that they are satisfied with the UFE procedure or remain free of fibroid symptoms 2 years after and a similar percentage of women report that they are still happy with their results 5 years after treatment.4 In comparison, rate of fibroid recurrence five years post-myomectomy can be up to 62.1%.3 UFE was also found to have required fewer days off work (10 versus 37 days) and fewer complications (22% vs 40%).5

Shorter Recovery: UFE uses image-guidance and not surgery. Abdominal myomectomy requires hospitalization and up to 6-8 week recovery period. After the UFE procedure you go home the same day with just a Band-Aid. Recovery time differs but in general lasts less than a week after UFE.

Make sure you understand your options and the surgical risks before agreeing to any procedure. Our vascular embolization expert sees patients in person and via virtual telehealth throughout California including Los Angeles, Inland Empire, San Diego and Orange County.

Patient Centered. Dedicated. Comprehensive.

References:

1. Rakotomahenina, H., Rajaonarison, J., Wong, L., & Brun, J.-L. (2017). Myomectomy: technique and current indications. Minerva Ginecologica, 69(4), 357–369.
2. Shiber, L.-D. J., & Pasic, R. (2018). Choosing the Correct Hysterectomy Technique. In I. Alkatout & L. Mettler (Eds.), Hysterectomy: A Comprehensive Surgical Approach (pp. 143–147). Cham: Springer International Publishing.
3. Memtsa, M., & Homer, H. (2012). Complications associated with uterine artery embolization for fibroids. Obstet Gynecol Int. 2012: 290542.
4. Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD005073.
5. Goodwin SC, Bradley LD, Lipman JC. UAE versus Myomectomy Study Group. Uterine artery embolisation versus myomectomy: a multicenter comparative study. Fertil Steril 2006;85:14–21

Contact California Vascular & Interventional today to find out if you are candidate for uterine fibroid embolization.

Who Performs Uterine Fibroid Embolization? (UFE)

Who performs uterine fibroid embolization (UFE)?

Uterine fibroid embolization is performed by a qualified Vascular and Interventional Radiologists, also referred to as IR, who train and specialize in minimally invasive image-guided procedures. A vascular and interventional radiology fellowship is the only medical specialty that formally trains physicians to become an embolization expert. See the video at the end of this page to learn more.

How long has fibroid embolization been performed by IR?

For over 20 years, Interventional Radiologists have performed uterine fibroid embolization (UFE), which provides women a non-surgical option to treat fibroids. This uterus saving procedure is only taught in an interventional radiology specialty fellowship, in addition to other types of embolization procedures. Embolization requires a thorough understanding and experience with different types of catheters, wires, and embolization materials to provide an effective and safe outcome.

Why California Vascular & Interventional?

Our Vascular and Interventional Radiologist at CVI is dedicated, highly qualified and has successfully performed numerous fibroid embolization procedures. In addition to fibroids, he has extensive experience in other types of embolization procedures including the liver, spleen, bowel, musculoskeletal, heart, lungs, prostate, and vascular diseases. Read here for more about our practice.

Contact us today to find out if you are candidate for fibroid embolization. You can obtain a consultation virtually via a video telehealth platform or meet our doctor in person at one of our office locations in Los Angeles or Southern California.

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