Varicocele Embolization Research Articles

Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications.

There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele.

Comparison of three different embolic materials for varicocele embolization: retrospective study of tolerance, radiation and recurrence rate.

To evaluate pain, radiation and recurrence rates in patients undergoing varicocele embolization with three different embolic materials. Retrospective study of 182 consecutive patients who underwent transcatheter retrograde varicocele embolization from July 2011 to May 2015 with glue (Glubran(®)2) (group 1, n=63), mechanical agents (coils and/or plugs) (group 2, n=53) or a sclerosing agent (polidocanol) (group 3, n=66). Patients were asked by telephone interview to evaluate pain during embolization and at 1, 7 and 30 days using a quantitative pain scale ranging from 0 to 10. Duration of scopy, kinetic energy released per unit mass (kerma) and dose area product (DAP) were assessed as radiation parameters during embolization procedures. Recurrence rates after treatment were also evaluated. Statistical analyses were performed using parametric and non-parametric tests. Patients in the three study groups were comparable for age, clinical indication and embolization side. No difference was noted for significant pain (pain score ≥3) during embolization and at 1, 7 and 30 days after treatment. Discomfort (pain score <3) was more frequent in group 1 than in groups 2 and 3 at 7 days after the procedure (P=0.049). No difference in discomfort was noted during embolization or at 1 and 30 days. Duration of scopy was shorter (P<0.0001) and kerma was lower (P=0.0087) in group 1 than in groups 2 and 3. DAP was lower in group 1 than in group 2 (P=0.04) but no difference was noted between groups 1 and 3, and groups 2 and 3. The recurrence rate at a mean follow-up of 24.4 months (range, 2-53 months) was significantly lower in group 1 than in the two other groups (P=0.032). The use of Glubran(®)2 acrylic glue for varicocele embolization is safe and leads to less radiation and lower recurrence rates than is the case for other embolic materials without any more significant pain.

Reassessing the Role of Subclinical Varicocele in Infertile Men With Impaired Semen Quality: A Prospective Study

To evaluate the seminal, hormonal, and spontaneous pregnancy outcome after percutaneous embolization of the internal spermatic vein in infertile men with left-sided subclinical varicocele and one or more abnormal semen parameters. A total of 218 patients underwent percutaneous embolization, and 119 patients were included as the observation group. All patients were followed up prospectively for 39.4 ± 6.5months. Semen parameters and hormonal levels were evaluated before any procedure and 6months after. Significant improvement in the mean sperm concentration, total motility, and lower follicle-stimulating hormone levels was noted in those who underwent varicocele embolization as compared with those not treated. After 39.4 ± 6.5months, pregnancy rates were 46.3% for the treated group and 11.8% for the control group (P= .011). In infertile men, small varicoceles, even subclinical ones, should be identified and treated.

5:45 PM Abstract No. 88 - Percutaneous varicocele embolization in the pediatric population: an effective outpatient treatment

5:45 PM Abstract No. 88 - Percutaneous varicocele embolization in the pediatric population: an effective outpatient treatment

Endovascular transcatheter embolization of recurrent postsurgical varicocele: anatomic reasons for surgical failure

Formation or pre-existence of collateral gonadal veins in varicocele patients has been reported as the main cause of surgical treatment failure. To describe venographic findings in patients with postsurgical recurrent varicoceles and to assess the efficacy of the following minimally invasive endovascular treatment. Thirty-three men with failed surgical treatment of left-sided varicocele were examined between 2006 and 2013, using retrograde venography to assess the anatomy of varicocele draining veins before the attempted transcatheter embolization. Anatomic variants of gonadal veins were categorized according to the classification modified for the purpose of the present study. 3% polidocanol was used as an embolic agent together with pushable fibered coils. In 31 (93%) out of 33 patients venography demonstrated incompetence of the gonadal vein or veins draining varicoceles after failed surgical treatment. The most frequent venographic finding was gonadal vein duplication - 66% of cases (39% in its mid-portion). Technical success of embolization was achieved in all 31 patients. No major complications were observed. Retrograde varicocele embolization may be superior to surgery because of its ability to detect gonadal vein variants. In our study group, transcatheter embolization with 3% polidocanol and fibered coils allowed successful, minimally invasive treatment of postsurgical varicoceles.

Radiation dose reduction in fluoroscopic procedures: left varicocele embolization as a model.

To investigate the effect of a radiation reduction program on total dose, fluoroscopy dose per second corrected for body habitus and degree of collimation in left varicocele embolizations (LVE). A radiation reduction program for LVE was implemented, consisting of a technique minimizing fluoroscopy time, using low-dose presets, virtual collimation, and virtual patient positioning. Height, weight, fluoroscopy time, kerma area product (KAP) and reference air kerma (Ka,r) were recorded for 100 consecutive cases satisfying the inclusion criteria. For each patient, a device specific dose correction factor, determined using a phantom, was used to standardize the KAP to that of the cylindrical diameter of the standard man and a collimation index was derived from the KAP and Ka,r. Median fluoroscopy time was 3 minutes (mean 4.5, range 1-23.8). Median KAP was 0.54 Gy/cm(2) (mean 0.82, range 0.12-6.52). There was a significant decrease in KAP/second corrected for cylindrical diameter (p < 0.001) and the collimation index (p < 0.001) over time. This study shows that a dedicated dose reduction program can achieve very low total radiation dose rates for LVE. The significant decrease in collimation index and standardized KAP per second during this study suggest a learning curve for collimation. • Left varicocele embolization can be performed with very low radiation doses. • The most effective real time radiation reduction measure is collimation. • There is a learning curve to achieving optimal collimation.

Percutaneous embolization: a viable treatment option for varicocele.

There are several options in the treatment of varicocele. Surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein have been used to treat varicocele [1]. Regardless of the chosen technique, the ultimate goal relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus [2]. Prasivoravong et al. [3] report results from a case series of men undergoing varicocele embolization. They evaluated men with grade III unilateral varicocele and identified improvements in sperm morphology. Percutaneous embolization can be a valuable treatment option for recurrences after surgery since patients may not want to undergo another operation and surgeons may not feel comfortable with artery and lymphatic sparing technique. Percutaneous approach can offer a viable treatment approach for men complaining of scrotal pain (orchialgia) from varicocele because inflammation and scarring from operation may contribute to additional pain. Further studies are necessary to determine the benefit of percutaneous embolization in men with bilateral and lower grades of varicocele. Additional comparative studies comparing the different treatment options for varicocele can help determine the best treatment option for men that present with varicocele-associated infertility.

Sclerosis and varicocele embolization with N-butyl cyanoacrylate: experience in 41 patients

Embolization is an established treatment for varicocele. Coils are most frequently used in the procedure. Liquid embolic and sclerosing agents seem to have a number of advantages over coils. To report our experience and explain the technique of using N-2-butyl-cyanoacrylate (N2BCA) in varicocele treatment. From January 2010 to July 2011, 42 gonadal veins in 41 consecutive patients (age range, 11-41 years; mean, 18 years) with a diagnosis of varicocele were treated with N2BCA as an embolic agent. The clinical diagnosis was confirmed by Doppler ultrasound in all patients. Institutional review board approval was obtained, and all the patients signed informed consent for this retrospective review. In all cases, a 4-F hydrophilic catheter was used to catheterize the distal portion of the gonadal vein through which N2BCA, emulsified with lipiodol, was injected. The technical success was 100%. No complications or non-targeted embolizations were reported. Seven patients reported moderate post-embolization pain that required oral analgesic treatment for 7-10 days. After 12-month follow-up, all patients exhibited varicocele resolution in the Doppler ultrasound examination as well as relief of all previous symptoms. We have no fertility-related data for patients treated for this condition. N2BCA as an embolic agent is a therapeutic alternative for the endovascular treatment of varicocele. This technique is uncomplicated, inexpensive, efficient, and safe.

Tolerance of glue embolization under local anesthesia in varicoceles: A comparative study of two different cyanoacrylates

PurposeTo find out whether in varicocele embolization the copolymer cyanoacrylate glue (NBCA-MS) has a better patient tolerance compared to the monomer n-butyl-2-cyanoacrylate (NBCA). Materials and methodsN=112 insufficient spermatic veins (left sided N=84, right sided N=28) diagnosed in N=83 adult males were prospectively randomized for blinded embolization with either NBCA N=54 (Histoacryl) or with NBCA-MS N=58 (Glubran2). Before, during and up to one week after embolization, patient discomfort was assessed by a standardized pain scale. Type, location and side of discomfort were noted.Statistical analysis was performed with the Mann–Whitney U-test, the McNemar test and the Fisher's exact test. ResultsEmbolization caused discomfort in N=48/112 (43%) spermatic veins, comprising N=26/54 (48%) in the NBCA group and N=22/58 (38%) in the NBCA-MS group. During the week after embolization, the overall number of discomfort reports rose to N=62/106 (59%), with an increase to N=30/53 (57%) in the NBCA group and to N=32/53 (60%) in the NBCA-MS group. The number of immediate grade 2 to 4 pain reactions was N=22/112 (20%), and rose to N=37/106 (35%) after one week. No difference in discomfort during embolization and at 1 week after treatment was noted. Characteristics, severity grading, and location of discomfort were similar in both NBCA groups, regardless the time point of observation. ConclusionDiscomfort after glue embolization of varicocele is a common side effect, which might evolve to pain. The assumed lower inflammatory reaction on NBCA-MS was not translated in an improved tolerance.

Varicocele surgery or embolization: Which is better?

: Varicocele remains the most commonly identified correctable cause of male factor infertility. Surgical correction is the most commonly performed technique to treat varicoceles with a technical failure rate of less than 5%. An attractive alternative to surgery is the selective catheterization and embolization of the gonadal vein. This data are limited by small series. : We reviewed a total of 158 patients. These patients underwent embolization for clinical varicoceles and male factor infertility between 2004 and 2008. Of these, 56% underwent attempted bilateral embolization, 43% unilateral left-sided embolization and 1.3% unilateral right-sided embolization. : Of these patients who underwent attempted bilateral embolization, 19.3% did not experience a successful obliteration of the right gonadal vein and 2.3% (2/88) experienced a failure rate in the embolization of the left gonadal vein. Of the 2 attempts at unilateral right-sided embolization, there were no failures. Of the 68 unilateral left-sided embolization attempts, there was a 4.4% failure rate. Of all of the right-sided embolization attempts, 18.9% failed, while 3.2% of the left-sided attempts failed. : This review represents the largest contemporary series of varicocele embolization outcomes currently in the literature. Our 19.3% technical failure rate for bilateral varicocele embolization is higher than the current published rate of 13% and is largely related to failure to successfully occlude the right gonadal vein. This supports our belief that bilateral varicoceles are best managed with a primary microsurgical approach, where technical failure rates are expected to be less than 5% based on published data. Men with unilateral left-sided varicoceles should be offered both options as they have similar failure rates, but with embolization offering some clear advantages to the patient.

Varicocele surgery or embolization: Which is better?

Introduction: Varicocele remains the most commonly identifiedcorrectable cause of male factor infertility. Surgical correction isthe most commonly performed technique to treat varicoceles with a technical failure rate of less than 5%. An attractive alternative to surgery is the selective catheterization and embolization of the gonadal vein. This data are limited by small series.Methods: We reviewed a total of 158 patients. These patientsunderwent embolization for clinical varicoceles and male factorinfertility between 2004 and 2008. Of these, 56% underwentattempted bilateral embolization, 43% unilateral left-sided embolization and 1.3% unilateral right-sided embolization.Results: Of these patients who underwent attempted bilateralembolization, 19.3% did not experience a successful obliterationof the right gonadal vein and 2.3% (2/88) experienced a failure rate in the embolization of the left gonadal vein. Of the 2 attempts at unilateral right-sided embolization, there were no failures. Of the 68 unilateral left-sided embolization attempts, there was a 4.4% failure rate. Of all of the right-sided embolization attempts, 18.9% failed, while 3.2% of the left-sided attempts failed.Conclusion: This review represents the largest contemporary series of varicocele embolization outcomes currently in the literature. Our 19.3% technical failure rate for bilateral varicocele embolization is higher than the current published rate of 13% and is largely related to failure to successfully occlude the right gonadal vein. This supports our belief that bilateral varicoceles are best managed with a primary microsurgical approach, where technical failure rates are expected to be less than 5% based on published data. Men withunilateral left-sided varicoceles should be offered both options as they have similar failure rates, but with embolization offering some clear advantages to the patient.

Endovascular embolization of varicoceles using n-butyl cyanoacrylate (NBCA) glue.

SummaryBackground:Varicoceles are abnormally dilated veins within the pampiniform plexus. They are caused by reflux of blood in the internal spermatic vein. The incidence of varicoceles is approximately 10–15% of the adolescent male population. The etiology of varicoceles is probably multifactorial. The diagnosis is based on Doppler US. Treatment could be endovascular or surgical.The aim of the study was to describe and evaluate a novel method of endovascular embolization of varicoceles using n-butyl cyanoacrylate (NBCA) glue.Material/Methods:17 patients were subjected to endovascular treatment of varicoceles using NBCA. A 2.8 Fr microcatheter and a 1:1 mixture of NBCA and lipiodol were used for embolization of the spermatic vein.Results:All 17 procedures were successful. There were no complications.Discussion:Embolization of varicoceles using NBCA glue is efficient and safe for all patients. The method should be considered as a method of choice in all patients. Phlebography and Valsalva maneuver are crucial for technical success and avoidance of complications.Conclusions:Endovascular treatment of varicoceles using NBCA glue is very effective and safe.

Vascular and Interventional Radiology

PART I: General Principles. Evaluation and Care of the Interventional Patient. Pharmacology. Vascular Biology and Physiology. Imaging Techniques. Access Techniques. Vascular Recanalization Technique. Vascular Occlusion Techniques. PART II: Vascular Diagnosis and Intervention. Thoracic Aorta. Abdominal Aorta. Upper Extremity Arteries and Veins. Lower Extremity Arteries. Mesenteric Arteries. Abdominal Arteries. GI Hemorrhage. Portal Venous System. Renal Arteries and Veins. Endocrine System. Pulmonary and Bronchial Arteries. Inferior and Superior Vena Cava. Lower Extremity Veins. Hemoodialysis Grafts. Varicocele Embolization. Vascular Access Placement. Vascular Foreign Body Retrieval. Vascular Complications of Transplantation. Lymphatic System. PART III: Non-Vascular Interventon. Percutaneous Biopsy. Percutaneous Fluid Drainage. Gastrointestinal Interventions. Transplant Complications. Biliary Interventions. GU Interventions. Pancreatic Interventions. Fallopian Tube Recanalization.

Angiographic Findings of Primary Versus Salvage Varicoceles Treated with Selective Gonadal Vein Embolization: An Explanation for Surgical Treatment Failure

Gonadal vein angioembolization is a successful means of primary and salvage treatment for symptomatic varicoceles. We aim to investigate angiographic findings during embolization of primary varicoceles vs those with failed surgical ligation. Between 1992 and 2010, 106 cases referred to our interventional radiologists for primary or salvage varicocelectomy were reviewed. These patients underwent venography and gonadal vein embolization using a combination of embolization coils and vascular plugs. All images were reviewed by an interventional radiologist to determine the anatomic etiology of the varicocele. Primary and salvage embolization cohorts were compared using t test and chi-square analyses for continuous and categorical variables, respectively. Angiographic parameters were analyzed using univariate and multivariable regression models to determine significance in predicting primary vs salvage status. Of the 106 patients, 46 patients (57 testicles) underwent primary and 60 patients (62 testicles) underwent salvage embolization. The salvage cohort of patients was younger (P<0.001) and comprised more solely left-sided pathology (P=0.002). An equivalent number of gonadal vein divisions and proportion of patent gonadal veins was found. However, there was a significantly higher proportion (27.8% vs 6.7%) of inguinal collateral vessels and combined presence of inguinal and retroperitoneal collateral veins (8.5% vs 2.1%) identified in the cohort undergoing embolization after failed surgical varicocelectomy. Presence of inguinal collaterals (P=0.008) as well as presence of both inguinal and retroperitoneal collaterals (P=0.038) on multivariable regression analysis revealed both as independent prognosticators of salvage status. Recurrence after surgical varicocelectomy is associated with increased inguinal collaterals. The pitfall presented by this anatomic variant to surgical ligation may be successfully managed with selective gonadal vein embolization.

Varicocele Retrograde Embolization with Boiling Contrast Medium and Gelatin Sponges in Adolescent Subjects: A Clinically Effective Therapeutic Alternative

Purpose Varicoceles occur in approximately 15% of adolescent male subjects and may impair future fertility. The present study describes a varicocele treatment technique involving percutaneous retrograde embolization with boiling hot contrast medium and gelatin sponge pledgets. Materials and Methods A retrospective review of medical records and imaging of all patients who underwent percutaneous retrograde varicocele embolization from 2005 to 2010 was performed. Pre- and postembolization symptoms, physical findings, and ultrasound findings were documented. Fifteen patients (16 embolizations) were identified, with an average age of 15.9 years (range, 12–18 y). Nine were referred because of persistent varicocele after surgical ligation. Three had grade 2 and nine had grade 3 varicoceles. Two had grade 1 varicoceles; one was painful and one was associated with poor semen quality. One varicocele was not clinically evident, but was associated with persistently decreased testicular size. Nine patients had pain or discomfort, and six had no discomfort. Clinical resolution was defined by a combination of symptom resolution and a lack of physical examination findings of varicocele or findings of treated varicocele. Results Fifteen of the 16 embolizations (94%) were technically successful. Clinical resolution was documented in 14 of 15 patients (95%); one patient experienced a recurrence at 30 months, which was successfully reembolized. One patient experienced temporary paresthesia of the left thigh. There were no major postprocedural complications. Mean follow-up duration was 11 months. Conclusions Retrograde embolization of varicoceles in adolescent subjects with the use of boiling hot contrast medium and gelatin sponges is a promising technique that appears effective.

Efficacy and Safety of Two Different n-Butyl-2-Cyanoacrylates for the Embolization of Varicoceles: A Prospective, Randomized, Blinded Study

This was a prospective, randomized, blinded comparative study of the efficacy and safety of two different n-butyl-2-cyanoacrylates (NBCAs) for embolization of varicoceles. A total of 112 insufficient spermatic veins (left-sided, n=84; right-sided, n=28) that were diagnosed in 83 adult males were prospectively randomized for blinded embolization with NBCA (n=54; Histoacryl, Braun, Germany) or NBCA-MS (n=58; Glubran2, General Enterprise Marketing, Viareggio, Lucca, Italy). Handling, embolic efficacy, and safety of both NBCAs were compared according the fulfillment of a standardized embolization plan, the occlusive effect on the spermatic vein, and the sticking to the microcatheter. Statistical analysis was performed with the Mann-Whitney U test and the Fisher's exact test. Patients of both study arms were comparable for age and clinical indication. Spermatic vein characteristics were comparable for varicocele classification and embolization side. Both NBCAs were equally efficient in occluding the spermatic vein and blocking reflux (NBCA, n=54/54, 100% vs. NBCA-MS, n=54/57, 94.7%; P=0.244). The embolization plan could be accomplished in an equal number of veins for both groups (NBCA, n=45/54, 83.3% vs. NBCA-MS, n=41/58, 70.7%; P=0.124). Adhesiveness of the glue to the microcatheter was the same in both NBCA groups (NBCA, n=25/54, 46.3% vs. NBCA-MS, n=29/58, 50%; P=0.71). No glue-related complications were noted. NBCA and NBCA-MS are equally efficient and safe glues for embolization of varicoceles.

Varicocele: Management and the continuing controversies

Varicoceles have long been associated with infertility. Despite this long history, there remains much controversy regarding their aetiology and management. The aim of this review is to present the mostcurrent information on the management of varicoceles and to highlight some of the management controversies: Association of varicocele with male infertility; Management of varicocele in adolescent; safety and effectiveness of varicocele embolization and management of subclinical varicoceles. It is hoped that this review study will stimulate further research into this condition in order to find a more common ground regarding its management.

330 PERCUTANEOUS VARICOCELE EMBOLIZATION IN CHILDREN: COMPARISON OF PRIMARY VS. SALVAGE THERAPY

You have accessJournal of UrologyPediatrics: Andrology-Cryptorchidism & Varicoceles1 Apr 2011330 PERCUTANEOUS VARICOCELE EMBOLIZATION IN CHILDREN: COMPARISON OF PRIMARY VS. SALVAGE THERAPY Sylvia Montag, Arvin George, Soroush Rais-Bahrami, Zhamshid Okhunov, Ardeshir Rastinehad, David Siegel, and Lane S. Palmer Sylvia MontagSylvia Montag New Hyde Park, NY More articles by this author , Arvin GeorgeArvin George Mineola, NY More articles by this author , Soroush Rais-BahramiSoroush Rais-Bahrami New Hyde Park, NY More articles by this author , Zhamshid OkhunovZhamshid Okhunov New Hyde Park, NY More articles by this author , Ardeshir RastinehadArdeshir Rastinehad Bethesda, MD More articles by this author , David SiegelDavid Siegel New Hyde Park, NY More articles by this author , and Lane S. PalmerLane S. Palmer New Hyde Park, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.413AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The treatment of varicocele by percutaneous embolization of the internal spermatic vein is a safe and effective technique with the potential of minimizing the morbidity traditionally associated with surgical management. The purpose of this study is to compare procedure characteristics of primary intervention versus salvage therapy for the treatment of clinically significant varicoceles in the pediatric population. METHODS A retrospective chart review of patients under 22 years presenting for percutaneous varicocele embolization was performed. Patient demographic and procedural characteristics were collected including patency of gonadal vein, number of divisions of gonadal vein, presence of retroperitoneal or inguinal collaterals, flouroscopy time, number of coils used, and postoperative complications. Patients were stratified according to primary varicoceles versus those with prior failed surgical varicocelectomy. Data was analyzed using Chi-square analysis and t-test where appropriate. RESULTS A total of 62 patients were underwent treatment with a mean age of 16.3 years (11–21). Mean followup was 8.8 months. There was no significant difference in presence of inguinal or retroperitoneal collaterals, or gonadal vein patency between the groups. Additionally, no difference was seen in flouroscopy time though there a greater number of microembolization coils were used for salvage treatment (9 vs. 13.9, p=0.012). CONCLUSIONS Salvage selective gonadal vein embolization is not associated with the presence of collateral veins. The primary reason for failed surgical varicocelectomy is a patent gonadal vein in the pediatric population. Salvage therapy did not result in increased radiation exposure © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e133-e134 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sylvia Montag New Hyde Park, NY More articles by this author Arvin George Mineola, NY More articles by this author Soroush Rais-Bahrami New Hyde Park, NY More articles by this author Zhamshid Okhunov New Hyde Park, NY More articles by this author Ardeshir Rastinehad Bethesda, MD More articles by this author David Siegel New Hyde Park, NY More articles by this author Lane S. Palmer New Hyde Park, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract No. 205: Results of varicocele embolization using sotradecol foam and fibered coils

Abstract No. 205: Results of varicocele embolization using sotradecol foam and fibered coils

Pregnancy after embolization of ovarian varicocele: report of two cases

We describe two cases of left-sided ovarian varicocele in patients with infertility. Pregnancy occurred in both women after successful retrograde venous embolization. Ovarian varicocele may be associated with infertility in some patients.