During your consultation with your doctor, factors such as your health, medical history and vascular condition will be evaluated to determine if endovenous laser treatment is right for you. This treatment method does not work for some types of veins, and certain contraindicating conditions may require further evaluation.
Traditional treatment of uterine fibroids has involved hysterectomy (surgical removal of the uterus) or other forms of treatment that left the women incapable of becoming pregnant. At ECCO, we prefer a safer, gentler, minimally-invasive procedure called uterine fibroid embolization, or UFE.
During this procedure, your Interventional Radiologist introduces a thin catheter into the arteries that feed these tumors, pinpointing their exact location via X-ray fluoroscopy. The doctor then injects a solution of embolizing particles into the arteries to close them, which causes the tumors they feed to shrink and die.
The UFE procedure is performed in our office-based laboratory on an outpatient basis. Because there are no large incisions, there are few risks for the procedure itself, and the lack of trauma to the uterus means that you retain your ability to become pregnant, if you so choose. Most patients report significant reductions of their reported symptoms, often as quickly as the next menstrual cycle.
Pelvic Congestion Syndrome (also known as ovarian vein reflux or pelvic venous disease) is a medical condition that has been widely underdiagnosed and misunderstood. For many years, women who complained of the painful symptoms of this condition were told, "It's all in your heads." It wasn't. It isn't.
Pelvic Congestion Syndrome is a constellation of symptoms caused when varicose veins develop in the pelvic area. These swollen veins occur because the valves in the veins that control the direction of blood flow are not functioning correctly. These swollen veins may occur after multiple pregnancies, or they may be the result of anatomic abnormalities such as May Thurner Syndrome.
The primary symptom is pelvic pain that becomes worse when you stand. When you are upright, because of the faulty vein valves, blood can't flow properly and begins to pool in the pelvis. This results in chronic, deep, debilitating, and gradually increasing pain, which often becomes worse as the day goes on. Symptoms may become worse during intercourse, and may worsen your menstrual cycle.
How is Pelvic Congestion Syndrome Treated at ECCO?
The treatment approach at ECCO is venogram with embolization, a minimally-invasive procedure that uses tiny, microscopic coils to close the diseased veins and re-route the blood supply to more competent veins. This enables the pooling blood to leave the pelvis, resulting in symptom relief. The procedure is performed on an outpatient basis in our office based laboratory, and most patients are able to return to their normal activities soon afterwards.
What Makes Pelvic Congestion Treatment Different at ECCO?
Many patients with pelvic venous disease have seen multiple providers and have had multiple imaging studies, but their symptoms persist. Part of the problem is that pelvic pain can have many different causes. Obstetricians often offer hysterectomy as a treatment, but if the cause of the patient's pelvic pain was vascular, then nothing is accomplished. Similarly, pain specialists may offer injections, but the cause of the symptoms is not neurologic, then again the treatment provides no relief.
At ECCO, we understand that "living with the pain" for months is not an option. So we take a unique approach to pelvic pain in women. Our Pelvic Pain Program evaluates all possible causes of your symptoms — uterine, endometrial, cervical, vascular, and neurologic. Once we have pinpointed the real cause of the condition, then we can begin to treat it properly, with therapies that have a proven history of working.
May-Thurner syndrome, also known as iliac vein compression syndrome or Cockett's syndrome, affects two blood vessels that go to your legs. It could make you more likely to have a DVT (deep vein thrombosis) in your left leg.
Your blood vessels carry blood to every part of your body. Your arteries move blood away from your heart, and your veins bring it back. Sometimes, arteries and veins cross over each other. Normally, that’s not a problem. But it is if you have May-Thurner syndrome.
This condition involves your right iliac artery, which carries blood to your right leg, and the left iliac vein, which brings blood out of your left leg toward your heart.
In May-Thurner syndrome, the right iliac artery squeezes the left iliac vein when they cross each other in your pelvis. Because of that pressure, blood can’t flow as freely through the left iliac vein. It’s a bit like stepping partway down on a hose.
The result: You’re more likely to get a deep vein thrombosis (DVT) in your left leg. A DVT is a type of blood clot that can be very serious. It’s not just that it can block blood flow in your leg. It can also break off and cause a clot in your lung. That’s called a pulmonary embolism, and it can be life-threatening.
With a DVT, your left leg may show symptoms such as:
If the DVT breaks off and forms a clot in your lungs, you may notice:
There are two goals: to treat any clots you already have and to keep new ones from forming.
Your doctor may talk to you about several options, including:
Angioplasty and a stent. This is a common treatment for May-Thurner syndrome. First, your doctor uses a small balloon to expand the left iliac vein. Then, you get a device called a stent. It’s a tiny cylinder, made of metal mesh, that keeps the vein open wide so blood can flow normally. The doctor may also use intravascular ultrasound to help put the stent in place.
Blood thinners . These drugs are often used to treat DVT. They can prevent new clots and keep ones you already have from getting bigger. Your doctor may call these medicines anticoagulants.
Bypass surgery. Your doctor builds a new path for blood to flow. You can think of it as a detour around the part of the left iliac vein that’s getting squeezed.
Clot busters. Doctors may use these to treat more serious clots. You might also hear this treatment called thrombolytic therapy. Your doctor uses a thin tube, called a catheter, to send the medication right to the site of the clot. The drug breaks it down in anywhere from a few hours to a few days.
Compression stockings. If your symptoms are mild and the doctor doesn’t think you need more treatment, he may suggest you wear these tight stockings that go from toes to knee. They put pressure on your lower legs that eases swelling and improves blood flow. You may have heard them called support hose.
Surgery to move the right iliac artery. This operation shifts the position of the artery so it sits behind the left iliac vein and no longer presses on it.
Surgical thrombectomy. This procedure to remove the clot is reserved for very large clots or those that are causing severe tissue damage.
Tissue sling. With this surgery, you get extra tissue put in that acts as a cushion between the two blood vessels.
Vena cava filter. You might get this if you can’t take blood thinners or if they don’t work well for you. Your doctor places a filter in your vena cava, a large vein in your belly. Although the filter won’t prevent clots from forming, it will catch them before they end up in your lungs.
Uterine fibroids are smooth, muscular tumors that form on the interior walls of the uterus. These growths appear during women's childbearing years, and are so common that a third of all women develop them by age 35, and as many as 70% to 80% of women develop them by age 50. African-American women tend to get them more often, and to develop them at younger ages.
Fortunately, these fibroids are non-cancerous, and do not increase a woman's chances of developing ovarian cancer. Many fibroids, in fact, cause no overt symptoms, and thus do not require treatment, other than "watchful waiting." However, for many women these benign tumors affect their menstrual cycles, and can cause debilitating symptoms, such as:
The ideal candidate for UFE is a postfertility, premenopausal patient with symptomatic uterine fibroids who strongly desires to avoid hysterectomy. Although there is no fixed size limitation, patients with pedunculated subserosal fibroids are not considered ideal candidates.
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