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Treatment of Symptomatic High-Flow Female Varicoceles with Stop-flow Foam Sclerotherapy

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Abstract

Purpose

To assess the efficacy of stop-flow foam sclerotherapy (SFFS) in high-flow pelvic varicoceles using 3 % sodium tetradecyl sulfate (STS) foam.

Methods

Our institutional review board granted approval and waived informed consent for this retrospective study of 26 patients (mean age 37.3 years, range 23–46 years) with pelvic congestion syndrome (PCS) who had high-outflow venous collaterals treated by SFFS between June 2005 and June 2011 in our department. PCS was diagnosed by physical and transvaginal color Doppler ultrasound examination, while high-outflow venous collaterals were detected at selective ovarian venography. SFFS was performed by injection of 3 % STS foam into the pelvic varices after balloon occlusion of the major venous vessels (hypogastric and/or ovarian veins) to which the high-outflow venous collaterals were tributary. Follow-up was performed at 1, 3, 6, and 12 months by physical and transvaginal color Doppler ultrasound examination and by a questionnaire-based assessment of pain using a symptom severity score.

Results

The procedure was technically successful in all patients. After the injection of 3 % STS foam, all patients had a colic like pain that spontaneously resolved after 5 min. During follow-up, no recurrences of PCS were detected. Significant improvement of symptoms (Student’s t test P < 0.01) was observed at 1, 3, 6, and 12 months.

Conclusion

SFFS using 3 % STS foam is a safe and effective treatment for high-flow female varicoceles and should be considered as an alternative to other endovascular and surgical options.

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References

  1. Venbrux AC, Lambert DL (2000) Ovarian and pelvic varices in the female patient. In: Savader SJ, Trerotola SO (eds) Venous interventional radiology with clinical perspectives, 2nd edn. Thieme Medical, New York, pp 210–216

    Google Scholar 

  2. Hobbs JT (1990) The pelvic congestion syndrome. Br J Hosp Med 43:200–206

    CAS  PubMed  Google Scholar 

  3. Meneses L, Fava M, Diaz P et al (2013) Embolization of incompetent pelvic veins for the treatment of recurrent varicose veins in lower limbs and pelvic congestion syndrome. Cardiovasc Intervent Radiol 36:128–132

    Article  PubMed  Google Scholar 

  4. Laborda A, Medrano J, de Blas I et al (2013) Endovascular treatment of pelvic congestion syndrome: visual analog scale (VAS) long-term follow-up clinical evaluation in 202 patients. Cardiovasc Intervent Radiol 36:1006–1014

    Article  PubMed  Google Scholar 

  5. Zondervan K, Yudkin P, Vessey M (2001) Chronic pelvic pain in the community—symptoms, investigations and diagnoses. Am J Obstet Gynecol 184:1149–1155

    Article  CAS  PubMed  Google Scholar 

  6. Hodgkinson CP (1953) Physiology of the ovarian veins during pregnancy. Obstet Gynecol 1:26–37

    CAS  PubMed  Google Scholar 

  7. Kurklinsky AK, Rooke TW (2010) Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc 85:552–559

    Article  PubMed Central  PubMed  Google Scholar 

  8. Giacchetto C, Cotroneo GB, Marincolo F et al (1990) Ovarian varicocele: ultrasonic and phlebographic evaluation. J Clin Ultrasound 18:551–555

    Article  CAS  PubMed  Google Scholar 

  9. Summit RI (1993) Urogynecologic cause of chronic pelvic pain. Obstet Gynec Clin North Am 20:685–715

    Google Scholar 

  10. Umeoka S, Koyama T, Togashi K et al (2004) Vascular dilatation in the pelvis: identification with CT and MR imaging. Radiographics 24:193–208

    Article  PubMed  Google Scholar 

  11. Desimpelaere JH, Seynaeve PC, Hagers YM et al (1999) Pelvic congestion syndrome: demonstration and diagnosis by helical CT. Abdom Imaging 24:100–102

    Article  CAS  PubMed  Google Scholar 

  12. Beard RW, Highman JH, Pearce S et al (1984) Diagnosis of pelvic varicosities in women with chronic pelvic pain. Lancet 2:946–949

    Article  CAS  PubMed  Google Scholar 

  13. Mathis B, Miller J, Lukens M (1995) Pelvic congestion syndrome: a new approach to an unusual problem. Am J Surg 61:1016–1018

    CAS  Google Scholar 

  14. Beard RW, Kennedy RG, Gangar KF et al (1991) Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associated with pelvic congestion. Br J Obstet Gynaecol 98:988–992

    Article  CAS  PubMed  Google Scholar 

  15. Carter J (1998) Surgical treatment for chronic pelvic pain. J Soc Laparoendosc Surg 2:129–139

    CAS  Google Scholar 

  16. Edwards RD, Robertson JR, MacLean AB et al (1993) Case report: pelvic pain syndrome—successful treatment of a case by ovarian vein embolization. Clin Radiol 47:429–431

    Article  CAS  PubMed  Google Scholar 

  17. Sichlau MJ, Yao JS, Vogelzang RL (1994) Transcatheter embolotherapy for the treatment of pelvic congestion syndrome. Obstet Gynecol 83:892–896

    CAS  PubMed  Google Scholar 

  18. Venbrux AC, Lambert DL (1999) Embolization of the ovarian veins as a treatment for patients with chronic pelvic pain caused by pelvic venous incompetence (pelvic congestion syndrome). Curr Opin Obstet Gynecol 11:395–399

    Article  CAS  PubMed  Google Scholar 

  19. Machan L, Mowatt J, Hurwitz T et al (1998) Clinical outcome of women with chronic pelvic pain treated by ovarian vein embolization. J Vasc Interv Radiol 9(suppl):185

    Google Scholar 

  20. Parsonn L, Stovall TG (1993) Surgical management of chronic pelvic pain. Obstet Gynecol North Am 20:765–775

    Google Scholar 

  21. Marsh P, Holdstock JM, Bacon JL et al (2008) Coil protruding into the common femoral vein following pelvic venous embolization. Cardiovasc Intervent Radiol 31:435–438

    Article  PubMed  Google Scholar 

  22. Chomyn JJ, Craven WM, Groves BM, Durham JD (1991) Percutaneous removal of a Gianturco coil from the pulmonary artery with use of flexible intravascular forceps. J Vasc Interv Radiol 2:105–106

    Article  CAS  PubMed  Google Scholar 

  23. Eclavea A (1998) Pelvic congestion syndrome: multicenter results. J Vasc Interv Radiol 9:184–185

    Article  Google Scholar 

  24. Gandini R, Chiocchi M, Konda D et al (2008) Transcatheter foam sclerotherapy of symptomatic female varicocele with sodium-tetradecyl-sulfate foam. Cardiovasc Intervent Radiol 31:778–784

    Article  PubMed  Google Scholar 

  25. Goffette P, Hammer F, Mathurin P et al (1995) Recurrence of varicocele after spermatic vein embolization in young patients: radiological aspect. Acta Urol Belg 63:55–56

    CAS  PubMed  Google Scholar 

  26. Tarazov PG, Prozorovskij KV, Ryzhkov VK (1997) Pelvic pain syndrome caused by ovarian varices: treatment by transcatheter embolization. Acta Radiol 38:1023–1025

    CAS  PubMed  Google Scholar 

  27. Capasso P, Simone C, Trotteur G et al (1997) Treatment of symptomatic pelvic varices by ovarian vein embolization. Cardiovasc Intervent Radiol 20:107–111

    Article  CAS  PubMed  Google Scholar 

  28. Cordts PR, Eclavea A, Buckley PJ et al (1998) Pelvic congestion syndrome: early clinical results after transcatheter ovarian vein embolization. J Vasc Surg 28:862–868

    Article  CAS  PubMed  Google Scholar 

  29. Maleaux G, Stockx L, Wilms G et al (2002) Ovarian vein embolization for the treatment of pelvic congestion syndrome: long term technical and clinical results. J Vasc Interv Radiol 11(7):859–864

    Article  Google Scholar 

  30. Venbrux AC, Chang AH, Kim HS et al (2002) Pelvic congestion syndrome (pelvic venous incompetence): impact of ovarian and internal iliac vein embolotherapy on menstrual cycle and chronic pelvic pain. J Vasc Interv Radiol 13:171–178

    Article  PubMed  Google Scholar 

  31. Pieri S, Agresti P, Morucci M et al (2003) Percutaneous treatment of pelvic congestion syndrome. Radiol Med 105:76–82

    PubMed  Google Scholar 

  32. Bachar GN, Belenky A, Greif F et al (2003) Initial experience with ovarian vein embolization for the treatment of chronic pelvic pain syndrome. Isr Med Assoc J 12:843–846

    Google Scholar 

  33. Tessari L, Cavezzi A, Frullini A (2001) Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg 27:58–60

    CAS  PubMed  Google Scholar 

  34. Gandini R, Konda D, Reale CA et al (2008) Male varicocele: transcatheter foam sclerotherapy with sodium tetradecyl sulfate: outcome in 244 patients. Radiology 246:612–618

    Article  PubMed  Google Scholar 

  35. Kanagawa H, Mima S, Kouyama H et al (1991) A successfully treated case of fundic varices by retrograde transvenous obliteration with balloon. Jpn J Gastroenterol 88:1459–1462

    CAS  Google Scholar 

  36. Kawanaka H, Ohta M, Hashizume M et al (1995) Portosystemic encephalopathy treated with balloon-occluded retrograde transvenous obliteration. Am J Gastroenterol 90:508–510

    CAS  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Rome, Italy

    Roberto Gandini, Daniel Konda, Sergio Abrignani, Marcello Chiocchi, Valerio Da Ros, Daniele Morosetti & Giovanni Simonetti

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  1. Roberto Gandini
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  2. Daniel Konda
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  3. Sergio Abrignani
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  4. Marcello Chiocchi
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  5. Valerio Da Ros
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  6. Daniele Morosetti
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  7. Giovanni Simonetti
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Correspondence to Daniel Konda.

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Gandini, R., Konda, D., Abrignani, S. et al. Treatment of Symptomatic High-Flow Female Varicoceles with Stop-flow Foam Sclerotherapy. Cardiovasc Intervent Radiol 37, 1259–1267 (2014). https://doi.org/10.1007/s00270-013-0760-6

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  • DOI: https://doi.org/10.1007/s00270-013-0760-6

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