Liquid and Solid Embolic Agents in Gonadal Veins.

Francesco Vacirca,Massimo Venturini,Francesco Tiralongo,Stefano Palmucci,Antonio Granata,Antonio Basile,Monica Palermo,Giulio Distefano,Francesco Giurazza

doi:10.3390/jcm10081596

Abstract

Male varicocele and pelvic congestion syndrome (PCS) are common pathologies with high predominance in young patients, having a high impact on the quality of life and infertility. Lately, the use of different endovascular embolization techniques, with various embolizing agents, shows good technical results and clinical outcomes. With the aim of presenting the “state of the art” of endovascular techniques for the treatment of male varicocele and PCS, and to discuss the performance of the different embolic agents proposed, we conducted an extensive analysis of the relevant literature and we reported and discussed the results of original studies and previous meta-analyses, providing an updated guide on this topic to clinicians and interventional radiologists. We have also underlined the technical aspects for the benefit of those who approach this type of interventional treatment. Our review suggests promising results in both the endovascular embolic treatment of male varicocele and PCS; for varicocele, a success rate of between 70% and 100% and a recurrence rate of up to 16% is reported, while for PCS it has been found that technical success is achieved in almost all cases of endovascular treatment, with a highly variable recurrence rate based on reports. Complications are overall rather rare and are represented by periprocedural pain, migration of embolic media and vascular perforations: severe adverse events have been reported very rarely.

Highlights

Scrotal varicocele in men and pelvic congestion syndrome (PCS) in women represent two relatively frequent pathological conditions in the young-adult population, with important implications on quality of life and a significant impact on fertility
For both male varicocele and pelvic congestion syndrome, different and heterogeneous endovascular treatment techniques have been reported for the local application of liquid or embolic agents, in some cases in combination
For the treatment of male varicocele with embolizing agents and endovascular techniques, a rather variable technical success rate is reported in the studies, ranging from 70% to 100%, and recurrence rates of up to

Summary

Introduction

Scrotal varicocele in men and pelvic congestion syndrome (PCS) in women represent two relatively frequent pathological conditions in the young-adult population, with important implications on quality of life and a significant impact on fertility. In these two conditions, gonadal venous vessels are abnormally dilated (sometimes secondary to other causes) and flow is slow and retrograde in the gonadal vein. We conducted an extensive analysis of the relevant literature through the PubMed and Google Scholar databases, re-evaluating previous meta-analyses, guidelines, original studies and case reports with the aim of illustrating the role of various embolic agents in male and female pathology and of providing an updated guide on this topic to clinicians and interventional radiologists. We reported the main clinical and instrumental features of scrotal varicocele and PCS and proposed a review of embolic agents, commenting on their indications, technical aspects, expected outcomes and possible complications in adult patients

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