Report from SIR: Sclerosing foam enhances embolization of varicose veins

Yale University researchers have introduced an endovascular technique that takes up a notch the embolization of the varicose veins that cause varicoceles and chronic pelvic pain.

The investigators described the technique, which combines microcoils with the injection of a foaming agent, in a study presented in Toronto at the annual meeting of the Society of Interventional Radiology.

Sodium tetradecyl sulfate, or STS, marketed as Sotradecol (Bioniche Life Sciences, Belleville, ON), further improves the value of an already minimally invasive treatment versus the standard surgical and laparoscopic approaches. The technique bolsters the prospects of men seeking answers to infertility problems. It also strengthens treatment alternatives available for a hard-to-find and often misunderstood condition affecting women, said coauthor Dr. Robert I. White, Jr., an interventional radiologist at Yale.

The embolization procedure seals off abnormally engorged varicose veins in the scrotum of patients with varicoceles, which cause testicular pain and gonadal atrophy. The goal is the same in female patients whose enlarged veins lead to abnormal blood pooling in the pelvic cavity, causing random but progressively incapacitating pain.

Interventionalists introduce a catheter in the femoral vein to deploy fibered coils that will block the internal spermatic or ovarian veins of men or women. They perform a quick contrast-enhanced venogram to light up small collateral vessels linked to the faulty veins, which were unreachable by previous methods. Then, they inject STS to clear contrast and place additional coils where appropriate by following gender-specific procedural guidelines.

To date, White and colleagues have treated 16 men with varicoceles and nine women with pelvic congestion syndrome (PCS). They have achieved successful embolotherapy in all patients.

Interventional radiologists in Canada and Europe have been using this embolization approach for some time, but several issues, including reimbursement levels, had delayed its U.S. acceptance. The technique allows interventional radiologists to treat testicular atrophy in young boys, reverse infertility in some men, and relieve debilitating pain in women nonsurgically and with local anesthesia, White said.

"When we are done, the patient leaves with only a Band-Aid," he said.

According to the clinical literature, varicocele can compromise the affected testicle's production and quality of semen. Current data available do not categorically prove that either surgery or embolization can improve men's fertility. A study published recently by researchers in the Netherlands, however, proved that varicocele embolization in infertile men significantly improved semen production, one among several causes of male infertility (Fertil Steril 2004;81[6]:1679-1683).

Italian investigators, on the other hand, had noted much earlier the economic impact of several therapeutic techniques, favoring intravenous sclerotherapy and embolization for their respectively lower cost (Arch Ital Urol Androl 1998;70[2]:57-64).

About one-third of all women will suffer from chronic pelvic pain during their lifetime. Women generally lie down during pelvic exams. This relieves blood pressure from ovarian veins and other vessels linked to PCS and makes varicose veins hard to detect. Many PCS patients thus end in front of a psychiatrist after seeing several specialists unable to find a cause for their pain. Current diagnostic imaging advances and embolotherapy have reversed this situation, White said.

"Most women I have treated have spent years looking for a solution to their chronic pelvic pain. As vascular experts, we can determine the cause of their pain and treat it if it has a vascular origin," he said.

For more information from the Diagnostic Imaging archives:

Ultrasound adds certainty to pelvic examinations

Improved techniques boost pelvic MR angio

Treatments offer hope in vascular malformations