Ovarian Vein Embolization with Penumbra Ruby XL Coils for PeVD Related Pain Achieves Complete Resolution of Symptoms

Dr. Marissa Famularo, DO, a vascular surgeon at Jefferson Health–Lehigh Valley in Bethlehem, Pennsylvania shares a recent case in which she used Penumbra’s Ruby^® Coils to embolize the left ovarian vein of a young woman who had experienced years of debilitating chronic pelvic pain (CPP) caused by pelvic venous disease (PeVD). Women who suffer from CPP often experience delays in care and often undergo unnecessary or ineffective treatments. For this patient, the embolization procedure was associated with resolution of pelvic symptoms, and Dr. Famularo reported that the embolization with Ruby Coils was easier to execute than previous systems.

Why Dr. Famularo chose Penumbra’s Embolization Platform:

• “Designed for Reliability: Repositioning is possible prior to mechanical detachment.”
• “Long coil lengths may decrease the need for multiple coils, potentially saving on procedure time and cost.”
• “In-hoop preparation and hand-off is much easier and more comfortable for my technologist. We don’t even need a long table for these procedures anymore.”

The following case study was originally published in Endovascular Today.

Patient Presentation

A woman in her late 20s presented to our vascular surgery clinic after referral from the CPP service. She reported years of debilitating pelvic pain and dyspareunia that significantly affected her quality of life and relationships. Despite evaluation by multiple specialists, she had not found relief until the CPP clinic identified PeVD as the underlying etiology. Cross-sectional imaging demonstrated a dilated left ovarian vein with large downstream pelvic varicosities.

Procedure

The patient underwent left ovarian vein embolization using Ruby Coils (Penumbra, Inc.), with complete resolution of her left-sided pelvic pain. However, at follow-up, she reported persistent, moderate right-sided pain. Given dilation of the right ovarian vein on her original imaging (Figure 1), she was brought back for diagnostic venography and subsequent right ovarian vein embolization. It is important to note that the dilated right ovarian vein is less likely to show reflux on CT imaging, even when venous timed. In this case, the right ovarian vein did light up on CT (Figure 2) but much less so when compared with the left ovarian vein.

Figure 1: Preoperative image from before the second procedure showing large dilated right ovarian vein (arrow).

Figure 2: Initial venogram of very large, dilated right ovarian vein.

For this second procedure, Ruby XL Coils were selected. Although a similar packed volume was required, only three coils were needed compared with 10 coils on the left. This reduced both procedure time and cost without compromising effectiveness.

At follow-up, the patient reported complete resolution of all pelvic symptoms and expressed high satisfaction with her outcome.

Figure 3: Postembolization venogram showing bilateral ovarian vein coil embolization with no distal reflux into the pelvic varicosities.

Learn more about the Ruby XL System.

Important Safety Information

Additional information about Penumbra’s products can be located on Penumbra’s website at https://www.penumbrainc.com/products/peripheral-embolization/. Caution: Federal (USA) law restricts these devices to sale by or on the order of a physician. Prior to use, please refer to Instructions for Use for complete product indications, contraindications, warnings, precautions, potential adverse events, and detailed instructions for use. Risk information can be found at peninc.info/risk. Please contact your local Penumbra representative for more information.

Images used with permission. Consent on file at Penumbra, Inc. Procedural and operative techniques and considerations are illustrative examples from physician experience. Physicians’ treatment and technique decisions will vary based on their medical judgment. The clinical results presented herein are for informational purposes only, and may not be predictive for all patients. Individual results may vary depending on patient-specific attributes and other factors.

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