Right ovarian vein

Fig.8.3a-c. Balloon-occluded retrograde transvenous obliteration for duodenal varices, a A varicogram obtained by-injection of sclerosant through a microcatheter advanced into the pancreaticoduodenal vein shows duodenal varices (arrowheads). A balloon catheter is inserted into the right ovarian vein (flrrow).b A contrast-enhanced CT obtained before BRTO shows duodenal varices (arrow), c A contrast-enhanced CT obtained 7 days after B-RTO shows thrombosis of the duodenal varices... 

Technical Difficulties in Right Ovarian Vein Cannulation 208... 

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]. 

F Multipurpose catheter (Cordis) (we use 7-F instead of 5-F because puncture hole size is not important in venous procedures as it is in arterial studies. The stiffness of the 7-F catheter is a considerable advantage when catheterizing the right ovarian vein)... 

F Sos or Simmons type II catheter for right ovarian vein... 

Inability to locate or cannulate the right ovarian vein is the most common reason for technical failure. The right ovarian vein origin is more variable in location than the left. It is usually located immediately anterior and inferior to the right renal vein orifice. The author s approach is to perform a right renal venogram to insure that the ovarian vein does not arise from the renal vein, and assess for accessory renal veins. I then withdraw the catheter to the... 

Fig. 17.12a,b. ovarian vein thrombosis. CT scans at the level below the renal hilum (a) and lower lumbar region (b). In a patient with bony metastasizing breast cancer (m), a nonoccluding thrombus (arrow) is identified within the dilated right ovarian vein (b). At the level just below the renal hilum, the renal vein (arrowhead) is patent (a)... 

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. 

Reversed flow in the ovarian veins can occur because of absent or incompetent valves, or because of structural or functional obstruction. Anatomical studies show that 13%-15% of women lack valves in the left ovarian vein and approximately 6% on the right and that when valves are present, 43% on the left and 35%-41% on the right are incompetent [3,4]. When the valves are incompetent, mean ovarian venous diameter increases from the normal of 3.8 mm to 7.5 mm [5]. 

A catheter, usually a Cobra catheter is introduced into the right femoral vein and directed into the peripheral left renal vein. Selective ovarian venog-... 

The ovarian vein is typically single, but may also be multiple and accompanies the ovarian artery. The venous drainage is into the left ovarian vein, and the inferior vena cava on the right side. 

Fig. 10.23a,b. Ovarian cancer recurrence. Coronal CT scans (a, b) in a patient with advanced recurrent clear cell cancer show multiple, predominantly cystic peritoneal implants throughout the abdomen and pelvis. The liver surface is compressed by surface implants (asterisk) (a, b). Multiple enlarged lymph nodes are seen in the right pelvis and root of the mesentery (b). Associated findings in this case include bilateral pleural effusion and a thrombus in the left femoral vein... 

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