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Left spermatic vein retrograde sclerosis: comparison between sclerosant agent injection through a diagnostic catheter versus through an occluding balloon catheter

  • URO-GENITAL RADIOLOGY
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Abstract

Purpose

The aim of this study was to compare the technical success between left spermatic vein (LSV) scleroembolisation achieved with the injection of sclerosant through a diagnostic catheter and through an occluding balloon (OB), in the treatment of male varicocele.

Materials and methods

From January 2012 to September 2013, we prospectively enrolled 100 patients with left varicocele and an indication for LSV scleroembolisation related to symptoms or spermiogram anomalies; patients were randomised to two groups (we wrote a list of 100 lines assigned casually with A or B and each patient was consecutively allocated to group A or B on the basis of this list). Patients in group A underwent injection of the sclerosing agent through an angiographic diagnostic catheter (free catheter technique) and patients in group B through an OB catheter (OB technique). In cases of incomplete occlusion of the LSV, the procedure was completed with coils. Total occlusion of the LSV at post-treatment phlebography during a Valsalva manoeuvre before any coil embolisation was considered a technical success. The rate of complications was also evaluated. The Fischer’s test was used for statistical analysis.

Results

We evaluated a total of 90 patients because five patients for each group were not included in the statistical analysis owing to technical problems or complications. In group A we had a technical success of 75.6 versus 93.4 % in group B, and the difference was statistically significant (P = 0.003); in particular, we had to complete the embolisation with insertion of coils in 11 cases (24.4 %) in group A, and in three cases in group B (6.6 %). In group A, LSV rupture occurred in four cases (8 %) so the procedure was completed by sclerosant injection through the OB located distally to the lesion. These patients were not considered for evaluation. In another case, a high flow shunt towards the inferior vena cava was detected, so the patient underwent OB injection to stop the flow to the shunt, and was not included for statistical evaluation. In group B, vein rupture with contrast leakage was noted in six cases (12 %); nonetheless, all the procedures were completed because the OB was positioned distally to the vessel tear, obviating any retrograde leakage of sclerosant. In group B, in five cases (10 %), we were unable to advance the OB though the LSV ostium so the procedures were completed with the diagnostic catheter and not considered for statistical evaluation.

Conclusion

On the basis of our data, the embolisation of the LSV obtained by injecting the sclerosant through an OB rather than through a diagnostic catheter seems to be more effective in achieving total vein embolisation, as well as allowing a controlled injection of sclerosant even in cases of vein rupture.

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Garibaldi Centro Hospital, Piazza Santa, Maria Del Gesù, Catania, 95124, Italy

    Antonio Basile, Giovanni Failla, Elena Mundo, Giuseppe Caltabiano, Marco Pizzarelli, Martina Messina & Giovanni Scavone

  2. Department of Radiology, Policlinico Universitario Vittorio Emanuele, Catania, Italy

    Giovanni Failla

  3. Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy

    Sandro La Vignera, Rosita Angela Condorelli, Aldo Calogero & Enzo Vicari

  4. Department of Nephrology, Ospedale Agrigento, Agrigento, Italy

    Antonio Granata

  5. Service of Andrology, ASP Siracusa, Siracusa, Italy

    Franz Lanzafame

  6. Department of Radiology, University La Cattolica, Rome, Italy

    Roberto Iezzi

  7. Department of Radiology, Medical School of Crete, University of Crete, Heraklion, Greece

    Dimitrios Tsetis

  8. Via Trieste 14, 95127, Catania, Italy

    Antonio Basile

Authors
  1. Antonio Basile
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  2. Giovanni Failla
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  3. Sandro La Vignera
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  4. Rosita Angela Condorelli
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  5. Aldo Calogero
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  6. Enzo Vicari
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  7. Antonio Granata
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  8. Elena Mundo
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  9. Giuseppe Caltabiano
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  10. Marco Pizzarelli
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  11. Martina Messina
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  12. Giovanni Scavone
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  13. Franz Lanzafame
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  14. Roberto Iezzi
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  15. Dimitrios Tsetis
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Corresponding author

Correspondence to Antonio Basile.

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Basile, A., Failla, G., La Vignera, S. et al. Left spermatic vein retrograde sclerosis: comparison between sclerosant agent injection through a diagnostic catheter versus through an occluding balloon catheter. Radiol med 120, 483–488 (2015). https://doi.org/10.1007/s11547-014-0478-9

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  • DOI: https://doi.org/10.1007/s11547-014-0478-9

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