Ovarian iliac vein

The uterine veins parallel the arteries forming the plexuses that end into the internal iliac vein uterine veins merge with vaginal plexus downward and with the ovarian veins upwards. Venous blood from... 

The same multipurpose shape catheter is then directed into the right ovarian vein. A right ovarian venogram and, if needed, embolization are performed in the same fashion as described for the left. If the ovarian venograms are negative, then bilateral internal iliac venograms are performed as rarely isolated pudendal vein reflux will cause symptomatic pelvic varicosities (Figs. 11.7a,b). We do not routinely study the internal iliac veins if ovarian vein reflux is found however, other interventionists do this routinely [34]. 

Clinical outcomes appear similar when the internal iliac veins are routinely occluded. Venbrux et al. (1999) followed 56 women for a mean of 22.1 months after embolization with coils and sodium morulate [36]. The internal iliac veins were also occluded in 43 of 56 patients at a separate procedure 3 to 10 weeks after ovarian vein embolization. The technical success rate was 100%. Three patients developed recurrent varices, two of whom were treated with repeat embolization. Using visual analogue scales to measure pain, a mean 65% decrease in VAS score was recorded. Two patients (4%) reported no change in their symptoms, no patients had worsening of their pain after embolization. 

Venbrux AC, Chang AH, et al. (2002) Pelvic congestion syndrome (pelvic venous incompetence) impact of ovarian and internal iliac vein embolotherapy on menstrual cycle and chronic pelvic pain. J Vase Interv Radiol 13 171-178... 

Variant anatomy of the ovarian arteries includes the gonadal artery originating from the renal artery in about 20% of individuals [2]. Very rarely the artery arises from the adrenal, lumbar, or iliac arteries [2]. In some cases, the right ovarian artery passes behind the cava and over the right renal vein. The left ovarian artery will occasionally also pass over the left renal vein [2], There is very rarely a common trunk of left and right gonadal arteries, and occasionally there are multiple gonadal arteries. 

Fig. 11.8. Left ovarian venogram via femoral route demonstrating dilated ovarian vein and paraovarian varicosities which drain into the left internal iliac venous system...

The ovarian artery originates from the lumbar aorta near the renal hilum. It is accompanied along its retroperitoneal course by the ovarian vein and the ureter on the anterior surface of the psoas muscle. It then crosses the ureter and common iliac vessels near the pelvic brim to enter the suspensory ligament of the ovary. The ovarian artery courses inferiorly and medially between the two layers of the broad ligament near the mesovarian border [4]. It forms multiple branches that reach the ovarian hilum via the mesovarium. It has a tortuous course that is most pronounced near the ovary. 

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