The Amplatzer Vascular Plug Also for Ovarian Vein Embolization

Abstract

We read with interest the paper by Tuite and colleagues [1] regarding their retrospective review of 23 consecutive cases of vascular embolization using the Amplatzer Vascular Plug (AVP), a new self-expanding nitinol wire mesh vascular embolization device delivered and released only when satisfactorily positioned. The AVP is commonly used in place of coils. The most frequent complication of coil embolization is coil migration if there were some problem in choosing the right size; other less common complications include erosion of the structures in which the coils are located, or infection [2, 3]. The standard treatment for female pelvic congestion syndrome is foam sclerotherapy into the ovarian vein below the level of the pelvic brim followed by coil embolization to within a centimeter of the vein origin [4, 5]. Commonly, due the fact that the ovarian veins are large, multiple coils are needed to complete the procedure, increasing the potential rate of the above-mentioned complications and the radiation exposure in young women. We treated a 39-year-old woman with pelvic congestion syndrome using sclerotherapy plus proximal ovarian vein embolization with AVPs (Fig. 1). We found delivery of the system to be very safe and quick. We needed only two AVPs (12 and 14 mm) (Fig. 1) and the patient is symptomfree after 9 months of follow-up. Even though larger series and longer follow-ups are needed we think that AVP embolization could be used also in ovarian vein embolization, partially obviating the limitations and complications of coil implantation and also reducing the radiation exposure in young women. To the best of our knowledge this is the first reported case of ovarian AVP embolization.