Liquid and Solid Embolic Agents in Gonadal Veins

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.

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

“…Marcelin stated that, in the venous district, these fluids have the great advantage over coils and sclerosing fluids of having good release control, the possibility to see how they distribute on fluoroscopy and both reduced risk of revascularization of the treated venous axis and of dangerous migration toward central venous system. The use of non-adhesive embolic fluids has also been described for the treatment of male varicoceles, with excellent clinical results and improved tolerance to the procedure in the post-embolization period [ 67 , 68 ]. However, it is reported that most patients experienced acute pain during the procedure.…”

“…However, it is reported that most patients experienced acute pain during the procedure. For this reason, associated with the high radiation dose administered to the typically young patient, there is no clinical indication for their use in clinical practice [ 68 ]. A further use of this type of embolization material has been described by Venturini et al, who demonstrate how squid in combination with coils were effective in the emergency treatment of bleeding esophageal varices in a hepatopathic patient with occluded transjugular intrahepatic shunt (TIPS).…”

Pelvic Congestion syndrome - common, but underdiagnosed disease of women

“…An occlusion of varices is obtained with application of embolization coils, particles or glue. Both technique and the materials used for embolisation vary in publications and the choice of method belongs to interventionist [17,18]. Due to its low rate of morbidity and complications it has largely replaced open surgical intervention for symptomatic ovarian vein incompetence.…”

Comprehensive overview of the venous disorder known as pelvic congestion syndrome

“…Due to the poor recognition of this disease, there is no definitive endovascular treatment protocol for PCS. Both the technique like the intravascular access site and the materials used for embolisation like sclerosants, coils, plugs vary in publications on this topic [ 98 ]. Studies comparing multiple embolisation agents are still lacking.…”