Role of Interventional Radiology in Gonadal Vein Embolization

Abstract

Background: 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 thesis discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele.
Objectives: The aim of this study is to highlight the role of interventional radiology in gonadal vein embolization in treatment of varicocele causing testicular pain or infertility.
Methods: A prospective interventional study including 26 patients suspecting varicocele presented by testicular pain or infertility, the patients underwent Varicocele embolization under local anesthesia with digital subtraction, then follow up was done after 2 weeks, 3 months and 6 months. The study was conducted in the Radiology Department at Ain-Shams University Hospitals, the period was between January 2019 till the end of July 2020.
Results: The procedure done for the different categories of the patients in our study, 19 patient underwent left ISV embolization, 4 cases underwent bilateral ISV, and in one patient we embolized right ISV, and failed at one case to catheterize ISV.
The study showed that there was statistically significant decrease in percentage of pain from 60% pre procedure to 25% post procedure with p-value = 0.025. And statistically significant increase in number and motility of the studied cases with p-value = 0.030 and 0.002 respectively on follow up. 54% of our patients underwent minor complications with 26.9% of them underwent post procedural pain, 8% ISV perforation, 15.4% underwent extravasation and we failed to catheterize the ISV in 4% of the cases.
Conclusion: Gonadal Vein Embolization is an effective way in treating varicocele, with our study showing significant improve as regard sperm count /ml, with significant decrease in the patient in comparison to pre and post procedural data, with highly significant improve sperm motility in 3 months follow up.