CLINICAL BACKGROUND
A 58-year-old woman on HRT presented with longstanding pelvic pain. The uterus and ovaries were normal on imaging, but pelvic MRI demonstrated extensive pelvic varices with prominent bilateral ovarian veins, consistent with pelvic venous insufficiency. There were no perineal or lower limb varicosities.

PROCEDURE
Right internal jugular vein access was obtained. Selective venography of the left ovarian vein, followed by the right, demonstrated severe reflux and filling of pelvic varices (Figure 1).
A tri-axial system comprising a 6F Arrow sheath, 4F MP catheter, and 2.8F Progreat microcatheter was used to provide stability during embolization. Both ovarian veins were embolized using a Glubran®:Lipiodol (1:4) mixture. Completion venography (Figure 3) confirmed successful occlusion of both ovarian veins with no residual reflux.

OUTCOME
The patient achieved complete resolution of her pelvic pain symptoms following treatment.

DISCUSSION
Glue embolization offers a cost-effective alternative to coil embolization, with deeper penetration into the pelvic variceal network. Internal iliac vein tributary assessment and embolization were not clinically required in this case but could be considered in a second-stage procedure if residual symptoms persisted.

LEARNING POINTS
1. MRI is valuable for identifying pelvic varices and refluxing ovarian veins in patients with chronic pelvic pain.
2. Right internal jugular access facilitates treatment of both ovarian veins.
3. A tri-axial catheter system provides excellent support for liquid embolic delivery.
4. Glue embolization is an effective and economical alternative to coil embolization.
5. Successful treatment of ovarian vein reflux can result in complete symptom resolution.

Figure 1: Severe reflux within the ovarian veins and pelvic varices.
Figure 2: Tri-axial catheter setup used for glue embolization.
Figure 3: Completion venography demonstrating successful bilateral ovarian vein embolization.