Clip and/or Glue Occlusion
Aim of Treatment
Coil embolisation was developed in the 1980’s, as an alternative to abdominal surgery, for control of leaking ovarian veins. This minimally invasive process involves insertion of surgical clips (coils) into the ovarian vein to occlude it along with sclerotherapy of pelvic varices to occlude them also.
Coil Occlusion
For some fifteen years very small stainless steel and Dacron coils have been used to occlude vessels in the body in areas such as brain, chest and abdomen. They constitute a similar technology to the use of surgical clips in open surgery. This technology has been used to treat larger varicose veins and large valve leakages in the lower limbs since 1998 and has proved effective in the majority cases. This process is known as “coil occlusion” or “coil embolisation”. The use of coils is generally restricted to larger vessels as small veins respond to injection treatment (sclerotherapy) alone. Most people with recurrent leg varicose veins and all patients with ovarian veins, can now avoid surgery. The use of coils is generally restricted to larger vessels, as small veins respond to injection treatment (sclerotherapy) alone. The majority of persons with recurrent leg varicose veins and all patients with ovarian veins can now avoid surgery.
Side Effects (Transient)
Pain: Pain occurs on injection of local anaesthetic and the sclerosant in the form of a stinging sensation. When the vein wall leaks sclerosant into the tissue this pain can be uncomfortable. Normally this resolves with no untoward event. Persisting pain usually indicates difficulties with the process and should be reported. For Laser treatments about 5 injections of local anaesthetic is required in the thigh to prevent pain from the heat of the Laser. If treatment is under anaesthesia then no pain occurs.
Cough: A cough may occur, with or without a feeling of tightness in the chest, but this resolves in 10-15 minutes. This can delay your departure after treatment.
Migraine: A migraine headache, unusual tingling or numbness of a limb or visual aura may occur but also resolves quickly. The sensation of numbness or weakness on one side of the body can last up to 15 minutes. No permanent complications have been documented.
Major Risks
Infection or Deep Vein Thrombosis.
Deep vein thrombosis requires hospital admission but the risk is less than 1:10,000. Infection requiring treatment has an incidence of less than 1:10,000. The use of occlusion coils for larger vessels has dramatically reduced the incidence of side effects from injection treatment. There is also the additional benefit of reducing the total dose of sclerosing Agent as well as reducing the risk of ulceration as a complication. The risk of coils moving from the original placement site after treatment is considered to be negligible but tangible. Loss of a coil during the actual procedure, however, would require removal of the coil by x-ray control through a catheter in the vein under local anaesthetic. Surgery to remove an incorrectly placed coil has not been required for any associated complication.
Treatment – What you need to know
Treatment is performed in the Radiology Department and should not be undertaken if there is a possibility that you are pregnant. It involves an injection of local anaesthetic in the right groin and the insertion of a catheter through a needle in the vein here. This catheter is then passed into the Ovarian (Gonadal) Vein and coils and sclerosant inserted. Sedation is available for this procedure if desired however if used you may not drive a vehicle afterwards for 12 hours. You may go home 2 hours after this procedure.
After Treatment
There will be some tendency for 2-3 days of abdominal discomfort but an unusual degree of pain following treatment should also be reported. There is no limitation on your activity following coiling of ovarian/testicular veins and activity is encouraged. Mild analgesia such as paracetamol can be used if required.
The Coils if Used
The devices commonly called “coils” are made either of chrome alloy and polyester or platinum and polyester. The devices used for this treatment are T.G.A. approved for use in Australia and have a long documented history of safe deployment. Like surgical clips they are inert after implantation.
There is a very small risk of infection (less than 1:10,000) with these devices. Infection would require removal of the coil, normally under local anaesthetic.
After treatment the coils are visible on plain x-ray and appear very much like surgical clips commonly used for abdominal surgery. They will not trigger a metal detection device such as those commonly used at airports. They are MRI compatible for MRI scanning. These coils, once implanted, are completely inert with less than 1:10,000 rejection rate.
Ovarian & Testicular Vein Treatment (Pelvic Congestion Syndrome)
Ovarian or testicular vein leakage is a common cause of varicose veins in the thigh, vulva, scrotum and perineum. The vein from the left ovary or testis drains to the kidney vein and is susceptible to leakage, just as with leg veins. In men, varicose veins in the scrotum are uncomfortable and can lead to sterility. Management of this problem has been by means of coil occlusion for over a decade and has proved very safe and reliable as a non-surgical procedure.
Any difficulties with treatment should be reported immediately by phone to this practice, rather than your local doctor. The result of your treatment, and/or significant complications, must be reviewed by Mr Milne before you can be discharged to your referring medical officer.
Costs
Our office will issue an estimate for your treatment. Substantial gaps between your fund rebate and Mr. Milne’s fee may occur and this will be shown on your quote. Rebates vary between fealth funds so your out of pocket cost is fund dependant. Laser treatment is more expensive at present as the rebates from insurers do not reflect the costs of the equipment, etc. Additional charges apply for ultrasound, anaesthetic and assistant services.