CIRSE Standards of Practice on Varicocele Embolisation

Long-term efficacy and catheter choice in male varicocele embolization using NBCA-MS glue

PURPOSE

This study investigated the long-term efficacy of n-butyl-2-cyanoacrylate-metacryloxysulpholane (NBCA-MS) for varicocele embolization (VE) without using a microcatheter.

METHODS

A retrospective study was conducted on male patients who underwent VE with NBCA-MS for grade III-IV varicocele between January 2016 and December 2022. Patients were categorized by the catheter type used. Telephone interviews assessed long-term effectiveness, focusing on relapse, re-treatment and spermiogram improvements.

RESULTS

Of 185 patients, 102 completed the phone interview (median age 25 years, median follow-up 4.1 years). Sixty-six procedures were performed with only an HH1 catheter (Group A, 65%), and 36 required an additional microcatheter (Group B, 35%), with Group A having a shorter median procedure time (30 vs. 36.5 min, p = 0.004). Long-term follow-up indicated a low recurrence rate (12%) and spermiogram improvement among a subset of patients (81%), with no significant difference in long-term efficacy between groups (relapse p = 0.244, re-treatment p = 1). Costs increased by 47-56% when adding a microcatheter plus a 0.018-inch guidewire.

CONCLUSION

The study confirms the effectiveness and safety of VE with NBCA-MS, demonstrating low recurrence rates and improvements in groin discomfort and fertility outcomes. In most cases of varicocele embolization using NBCA-MS, microcatheters can be avoided, reducing procedural costs and duration without compromising long-term efficacy.

Transcatheter arterial and venous embolisation with α-hexyl cyanoacrylate MagicGlue®: short-term safety and efficacy outcomes

PURPOSE

Our purpose was to assess the feasibility and the short-term safety and efficacy outcomes of a wide range of transcatheter arterial and venous embolisation procedures done using α-hexyl-cyanoacrylate (AHCA)-MagicGlue® in patients with bleeding and non-bleeding disorders.

METHODS

This single-centre retrospective study included consecutive patients who underwent emergent or planned AHCA-MagicGlue® transcatheter embolisation between February 2019 and September 2023. Technical success, clinical success, 30-day mortality, and complication rates were evaluated.

RESULTS

We included 101 patients with a mean age of 49.9 ± 20.5 years who underwent arterial (n = 43, 42.6%) or venous (n = 58, 57.4%) embolisation for bleeding (n = 16, 15.8%) or other reasons (n = 85, 84.2%). The technical success rate was 100%. After a mean follow-up of 2.2 months, the clinical success rate was 94% in patients with bleeding and 95% in other patients; 1 patient died of multi-organ failure unrelated to the procedure. In the 22 patients with prostatic artery embolisation, statistically significant improvements were recorded at 3 months versus baseline for the International Prostate Symptoms Score (IPSS) (10.0 ± 5.8 vs. 20.8 ± 7.3, p = 0.001), IPSS quality-of-life score (2.0 ± 1.4 vs. 5.0 ± 1.0; p = 0.001), and prostate volume (67.8 ± 38.0 mL vs. 96.7 ± 47.4 mL, p = 0.001). Adverse events occurred in 11 (10.9%) patients and were major in 4 and minor in 7 patients.

CONCLUSIONS

MagicGlue® transcatheter arterial and venous embolisation is feasible, effective, and safe for bleeding and non-bleeding conditions across a broad range of anatomic sites.

Percutaneous Embolization for Painful Varicocele: An 8-Year Tertiary Centre Experience

Background: Varicocele is a common condition in men that can lead to several clinical problems. Treatment modalities include surgical and non‑surgical methods. There has been no randomized controlled trial proving the superiority of one treatment approach over another. Materials and methods: We conducted an 8‑year retrospective analysis of varicocele embolization procedures at our department of Interventional Radiology. Demographic data, procedure details, procedure success and complications were collected. Telephone interviews were also conducted at the time of the study. Results: A total of 182 interventions were performed. Median age of patients at presentation was 31 years (range, 12-71). Median follow‑up duration was 44.5 months (range, 3.4-106.9). Employed embolic agents were coils in 171/182 (91.94%) cases. Technical success rate was 88.15%. Ultrasonographic success was accomplished in 44.87% patients. Clinical success rate in patients referred for scrotal pain was 70.42%. Fluoroscopy time was 20.3 ± 14.9 min (mean ± SD), dose area product was 63.2 ± 50.5 Gy∙cm² (mean ± SD) and kinetic energy released per unit mass was 193.2 ± 173.6 (mean ± SD). Minor complications were encountered in 19/182 (10.45%) of the interventions. Conclusions: Varicocele embolization was found to be an efficient and safe procedure for patients referred for scrotal pain. Randomized controlled trials are warranted to elaborate treatment algorithms in varicocele patients.

"Management of andrological disorders from childhood and adolescence to transition age: guidelines from the Italian Society of Andrology and Sexual Medicine (SIAMS) in collaboration with the Italian Society for Pediatric Endocrinology and Diabetology (SIEDP)-Part-1"

PURPOSE

Andrological pathologies in the adulthood are often the results of conditions that originate during childhood and adolescence and sometimes even during gestation and neonatal period. Unfortunately, the reports in the literature concerning pediatric andrological diseases are scares and mainly concerning single issues. Furthermore, no shared position statement are so far available.

METHODS

The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving the Italian Society of Pediatric Endocrinology and Diabetology (SIEDP) to provide an updated guideline on the diagnosis and management of andrological disorders from childhood and adolescence to transition age. Derived recommendations were based on the grading of recommendations, assessment, development, and evaluation (GRADE) system.

RESULTS

A literature search of articles in English for the term "varicoceles", "gynecomastia", "fertility preservation", "macroorchidism", "precocious puberty" and "pubertal delay" has been performed. Three major aspects for each considered disorder were assessed including diagnosis, clinical management, and treatment. Recommendations and suggestions have been provided for each of the mentioned andrological disorders.

CONCLUSIONS

These are the first guidelines based on a multidisciplinary approach that involves important societies related to the field of andrological medicine from pediatric to transition and adult ages. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving andrological and general health of the transitional age.

Spermatic vein sclero-embolization through basilic vein access: A short communication

Objectives: To depict the basics of percutaneous spermatic vein sclero-embolization through a right basilic vein access and to qualitatively assess the reduced discomfort and pain of this access compared to the femoral one through a VAS scale. Methods: From February 2019 to March 2020, 20 varicocele sclero-embolizations through a right basilic vein were performed and retrospectively evaluated. All patients were men with a median age of 24.5 years. Treatment technique is described, as well as mean radiation dose and procedural time, and complication rates. Results: Technical success was obtained in all patients. 1 access site complication requiring conversion to femoral access occurred. 100% of patients reported only a "mild" pain ranging from 1 to 3 on VAS scale, suggesting a comfortable access for this procedure. Conclusions: Basilic vein access determines easy left and right spermatic vein catheterization, rapid ambulation as well as easy monitoring of the access site for post-procedural evaluations.

Migration of sclerosant material to the left renal vein following coil embolisation of a varicocele

Percutaneous testicular varicocele embolisation for symptomatic and subfertile males is often preferred over surgical ligation of the gonadal vein due to its minimally invasive approach and reduced complication rate. Glues, coils, vascular plugs, balloons and sclerosants are used in various combinations to achieve sufficient venous occlusion. Here, we report on the first known case of sclerosant material migration beyond the placement of an embolisation coil for treatment of a varicocele, resulting in a left renal vein thrombus. A man in his 20s presented to the emergency department 2 days following uncomplicated left varicocele embolisation with acute left-sided abdominal pain, found to have sclerosant material causing an ipsilateral non-occlusive left renal vein thrombus with extension towards his inferior vena cava on CT. He was treated with 3 months of anticoagulation and follow-up imaging at 3 months showed resolution of this thrombus without renal impairment.

Antegrade embolization of varicocele with cyanoacrylate glue: a case report

BACKGROUND

Varicocele embolization is an effective, minimally invasive treatment option, with a symptom improvement rate of around 90%. However, anatomical variations and post-embolization recurrences pose challenges to its efficacy. This article discusses the antegrade embolization technique as a viable alternative for cases in which retrograde embolization fails, offering a broader spectrum of treatment options for varicocele.

CASE PRESENTATION

This case report details the treatment of a 27-year-old male with a left varicocele, diagnosed during infertility assessment, using an alternative embolization technique. Despite initial failed attempts at retrograde catheterization via the femoral vein, a direct inguinal puncture of the left testicular vein was successfully performed under ultrasound guidance. A mixture of Glubran® and Lipiodol® was used for embolization, achieving varicocele embolization without complications. The patient was discharged 2 hours post-procedure, with follow-up confirming the procedure's effectiveness and safety.

CONCLUSION

This article introduces a less invasive, ultrasound-guided technique for varicocele embolization, presenting a viable alternative to surgery when conventional retrograde methods fail.

A cost outcome study of varicocoele embolisation and future pregnancy in an Australian public hospital setting

INTRODUCTION

Varicocoele is commonly encountered in males with infertility. Studies have shown that varicocoele repair (surgery or embolisation) can improve the rate of subsequent pregnancy. In Australia, there have been no studies assessing the cost of varicocoele embolisation and current practice is based on international data. This study aimed to assess the cost of varicocoele embolisation and estimate the treatment cost per pregnancy.

METHODS

Retrospective cost-outcome study of patients treated by embolisation between January 2018 and 2023. A bottom-up approach was used to calculate procedure costs whereas a top-down approach was used to calculate costs for all other patient services, including direct and indirect costs. To calculate cost per pregnancy, costs were adjusted according to existing published data on the rate of pregnancy after embolisation.

RESULTS

Costing data from 18 patients were included, of median age 33.5 years (range 26-60) and median varicocoele grade 2.5 (range 1-3). All patients had unilateral treatment, most commonly via right internal jugular (16 patients, 89%) and using a 0.035″ system (17 patients, 94%). The median cost for the entire treatment including procedural, non-procedural, ward and peri-procedural costs was AUD$2208.10 (USD$1405 or EUR€1314), range AUD$1691-7051. The projected cost to the healthcare system per pregnancy was AUD$5387 (USD$3429 or EUR€3207).

CONCLUSION

Total varicocoele embolisation cost and the cost per-pregnancy were lower than for both embolisation and surgical repair in existing international studies. Patients undergoing varicocoele treatment should have the option to access an interventional radiologist to realise the benefits of this low-cost pinhole procedure.