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

Migration of varicocele coil leading to ureteral obstruction and hydronephrosis: A case report

BACKGROUND

Varicocele embolization, a minimally invasive treatment for symptomatic varicoceles, carries a rare risk of complications like ureteral obstruction and hydronephrosis. This case report documents such a case to raise awareness of these potential complications and showcase minimally invasive surgical management as a successful solution.

CASE SUMMARY

A 35-year-old male presented with flank pain and hematuria following varicocele embolization. Imaging confirmed left ureteral obstruction and hydronephrosis. Laparoscopic ureterolysis successfully removed the embolization coil and repaired the ureter, resolving the patient's symptoms. Follow-up at six months and two years showed sustained improvement.

CONCLUSION

Minimally invasive surgery offers an effective treatment option for rare complications like ureteral obstruction arising from varicocele embolization.

A review of the pathophysiology and evidence-based management of varicoceles and pelvic congestion syndrome

Pelvic congestion syndrome (PCS) in females and varicoceles in males may be regarded as closely related conditions since the main pathophysiological cause for both processes is pelvic venous insufficiency. Varicoceles are more prevalent amongst sub-fertile males, with an approximate incidence of 15% in the general male population. PCS is commonly diagnosed amongst premenopausal multiparous women, representing one of the leading causes of chronic pelvic pain. Both conditions appear to be predominantly left-sided and are associated with oxidative stress and pro-inflammatory cascades with subsequent effects on fertility. Clinical examination and pelvic ultrasonography play an essential role in the assessment of varicoceles, PCS and chronic pelvic pain. Venography is generally considered as a gold-standard procedure for both conditions. There is still much debate on how these conditions should be managed. This review article provides a comparative analysis of the underlying pathophysiological mechanisms of both PCS and varicoceles, their impact on fertility, as well as their clinical management.

Liquid Embolic Agents for Endovascular Embolization: A Review

Endovascular embolization (EE) has been used for the treatment of blood vessel abnormalities, including aneurysms, AVMs, tumors, etc. The aim of this process is to occlude the affected vessel using biocompatible embolic agents. Two types of embolic agents, solid and liquid, are used for endovascular embolization. Liquid embolic agents are usually injectable and delivered into the vascular malformation sites using a catheter guided by X-ray imaging (i.e., angiography). After injection, the liquid embolic agent transforms into a solid implant in situ based on a variety of mechanisms, including polymerization, precipitation, and cross-linking, through ionic or thermal process. Until now, several polymers have been designed successfully for the development of liquid embolic agents. Both natural and synthetic polymers have been used for this purpose. In this review, we discuss embolization procedures with liquid embolic agents in different clinical applications, as well as in pre-clinical research studies.

Embolization in Pediatric Patients: A Comprehensive Review of Indications, Procedures, and Clinical Outcomes

Embolization in pediatric patients encompasses a large spectrum of indications, ranging from the elective treatment of congenital diseases of the cardiovascular system to the urgent management of acute hemorrhagic conditions. In particular, the endovascular treatment of central and peripheral vascular malformations and hypervascular tumors represents a wide chapter for both congenital and acquired situations. Thanks to the progressive availability of low-profile endovascular devices and new embolic materials, the mini-invasive approach has gradually overtaken surgery. In this review, the main embolization procedures will be illustrated and discussed, with a focus on clinical indications and expected outcomes. The most recent mini-invasive techniques will be described, with hints on the cutting-edge devices and embolic materials.

Endo-bronchial application of glue in the management of hemoptysis

BACKGROUND

Hemoptysis from varied etiologies, often fails to respond to conservative therapy. The conventional managements of such a situation are Bronchial Artery Embolization (BAE) or thoracic surgery which is often not possible. Endoscopic application of glue may stand as a method of therapy in these circumstances.

METHODS

202 patients of hemoptysis were treated by video-bronchoscopy assisted endobronchial application of glue (n-butyl cyanoacrylate) with the help of polyethylene catheter being placed through the working channel. The details of the procedure and their 6 month follow up are presented.

RESULTS

Immediate control of hemoptysis was achieved in 183 i.e. 90.59% of patients. 19 patients had a partial response, i.e., hemoptysis stopped and then recurred, endobronchial application of glue was repeated in them out of which 14 (6.9%) responded to the second procedure whereas 5 (2.47%) failed to show any response in spite of the repeated procedure. The complication rate was 0.49% in the form of glue migrating into the trachea. There was no mortality.

CONCLUSION

Endobronchial application of glue for hemoptysis can be an effective, economic and alternative therapy for mild to moderate hemoptysis.

Contribution to the Pathophysiology and Treatment of Varicoceles

Anatomical differences between adults and adolescents and between left and right varicoceles were shown in this work. We designed a standardized and reproducible method for pressure measurement in the inguinal internal spermatic vein (ISV). We demonstrated that the mean absolute pressure in the ISV in the upright position is higher than the veno-capillary pressure in the testicle, and hence could impair spermatogenesis prompting the need for treatment in varicoceles.

Histoacryl transparent and Glubran2, the current commercially available adhesives for the treatment of varicoceles, do not differ with regard to efficiency, safety and tolerance during and after embolization. Both adhesives cause a mild pain in 30% of the patients in the week after embolization. The radiation exposure is low during embolizations of varicoceles with highly viscous liquid products. Therefore, the endovascular treatment with glue is an efficient, safe and tolerable method of treatment for varicoceles when applicable.

Varicocele embolization with glue and coils: A single center experience

PURPOSE

The purpose of this study was to compare metallic coils and glue (n-butyl-2 cyanoacrylate) for varicocele embolization, regarding immediate technical and clinical success, procedure time, complications and recurrence rates.

MATERIALS AND METHODS

A retrospective analysis of a consecutive series of varicocele embolization procedures performed between July 2012 and July 2015 was undertaken. A total of 129 procedures were performed, 26 using glue (20.2%; 26 men with a mean age of 32.6 years) and 103 using coils (79.8%; 103 men with a mean age of 32.3 years). Demographic data, indications, technique, procedure time, complications and outcomes were compared.

RESULTS

A total of 89 procedures (69%) were motivated by infertility (glue=20, coils=69) and 40 (31%) by testicular pain (glue=6, coils=34). The mean procedure time was 35.58±13.44 (SD) min for glue and 45.97±17.46 (SD) min for coils (P=0.0054). Immediate technical success rate was 100% using glue and 99% using coils (P=1.0000). A single minor complication was observed after coil embolization (0.97%). Both materials showed significant improvement of semen parameters, with similar clinical success rates. For patients referred for testicular pain, clinical success rate was 66.67% using glue and 88.24% using coils (P=0.2147). Recurrence rate was 11.54% with glue and 5.83% with coils (P=0.4000). Procedure time was significantly shorter with glue (P=0.0054).

CONCLUSION

Glue and coils are both safe and effective for varicocele embolization. However, the use of glue yields shorter procedure time.

Long-standing hemospermia in a patient with megacava associated to a circumaortic renal vein

Hemospermia may have a broad range of functional and organic causes. It is defined as the presence of blood in seminal fluid and usually tends to resolve spontaneously within a few weeks. We present the case of a patient with a 10-year history of hemospermia associated with megacava and circumaortic renal vein. The diagnosis, treatment, and evolution of the condition are reported. Vascular anomalies are rare causes of chronic hemospermia, and the one described in our patient may constitute the first case reported in the literature.