We at Vascular Anomalies Clinic of Jerusalem (Israel) offer comprehensive treatment options for many women’s health issues including uterine fibroid embolization, treatment of pelvic congestion syndrome, and treatment of varicose veins.
Uterine fibroids are noncancerous growths in the uterine wall which affect up to half of women over thirty-five years of age and can cause heavy menstrual bleeding and pain.
Chronic pelvic pain may be caused by varicose veins in the pelvis and occurs in one in eight women from twenty to fifty years of age.
Treatment of varicose veins in the legs is not just a cosmetic issue; varicose veins can cause pain, swelling and blood clots.
We provide the most effective and least invasive techniques to treat these conditions in most patients providing excellent results with minimal recovery times.
We are committed to delivering the highest quality of individualized treatment and compassion. We make every effort to ensure comfort and to control pain. Our patients receive frequent follow up phone calls after discharge to answer questions and provide guidance when needed.
Uterine Fibroids are benign (non-cancerous) tumors of the uterus . They are very common and may be found in up to 40% of adult women. The fibroids cause significant symptoms in a minority of these women, including prolonged and heavy bleeding during or between monthly periods, pelvic pain, a feeling of heaviness in the pelvis, or from symptoms related to pressure on the urinary bladder or rectum.
Traditional treatment options for symptomatic fibroids include oral contraceptives or surgery. Many women are candidates to have only the fibroids removed (myomectomy or partial hysterectomy), though some require the uterus to be removed, due to the size or number of the fibroids.
Uterine Fibroid Embolization (UFE) is a minimally-invasive alternative to surgery for fibroids. It involves the placement of a tiny catheter into an artery in the upper leg. The catheter is then navigated to the arteries of the uterus, where microscopic particles are injected to block off the blood supply to the uterine fibroids. Nearly all women will go home either the same day or after one night’s hospital stay and fully return to normal activities within a few days.
Some women will experience minor pain and/or low grade fever for a few days after the procedure and these are managed with medications. Women typically experience pain during the procedure and for the first 24 hours after the procedure. This is managed either by spinal anesthesia (similar to childbirth), or by intravenous and oral pain medication.
UFE vs. Surgery
The benefits of UFE over surgery include much shorter hospital stay and recovery time, a shorter time to resuming normal activities, and avoidance of the potential complications associated with major surgery (wound infections, abdominal infections, bleeding, scarring…). Multiple clinical trials of the highest scientific standards have shown UFE to be equal or superior to surgery in terms of relief of symptoms and patient satisfaction.
The downside to UFE include a need for a seconday procedure (UFE or surgery) in about 1 in 5 women. In addition, if a woman desires future children and is a candidate for myomectomy (partial hysterectomy), surgery is still the preferred treatment, though many women have had successful pregnancies after UFE. Women considering UFE will also need to undergo an MRI prior to treatment in order to evalute the anatomy and blood supply to the fibroids.
We would be happy to discuss UFE at our vascular anomalies clinic in Jerusalem and take all the time you need, to answer questions/concerns.
The UFE procedure is covered by many of the kuppot and insurance companies, though not all. We typically appeal to the kuppot/insurance companies on an individual basis, and will make every effort to assist in obtaining a hitchayvut for the procedure.
Pelvic Congestion Syndrome and Pelvic Varicose Veins
Chronic pelvic pain has many potential causes. One of the more common causes is termed Pelvic Congestion Syndrome (PCS) or “pelvic varicose veins.” The symptoms of PCS may include pelvic pain or fullness, typically worse after standing, or from symptoms related to pressure on the urinary bladder or rectum. Patients’ pain typically gets worse around the time of their monthly period, during pregnancy, or around the time of sexual intercourse.
Women may also present with dilated veins (“varicose veins”) on their upper legs/thighs or around the external genitalia. This may or may not be associated with the above symtoms of PCS.
It is often difficult to ascribe a women’s symptoms definitely to PCS, and women typically undergo evaluation by a gynecologist which may include CT or MRI, and sometimes laparoscopic surgery in order to look for other possible causes of pelvic pain, such as endometriosis. In no other cause is found, and the patient has dilated veins in the pelvis, then PCS may be appropriately diagnosed.
The treatment for PCS involves a non-surgical procedure, where a small catheter is inserted into the pelvic veins in order to close them off (“embolization”). Women typically experience no pain or minor pain for the first 24-48 hours, which is managed with oral pain medication. The procedure typically takes about 1-2 hours and patients are able to go home on the same day of the procedure. If PCS is in fact the appropriate diagnosis, this catheter based procedure carries a very high success and patient satisfaction rate (75-90%).
In the past, the only treatment option for PCS was removal of the uterus, a far more invasive procedure. Even with hysterectomy, about 25% of women with chronic pelvic pain do not experience significant pain relief.
For patients with painful or unsightly dilated veins in the area of the external genitalia, direct injection of the dilated veins (“sclerotherapy”) can be performed.