Gonadal vein embolization: treatment of varicocele and pelvic congestion syndrome.

Vanderbilt University and Vanderbilt Children's Hospital, Nashville, Tennessee.
Seminars in Interventional Radiology 09/2008; 25(3):261-70. DOI: 10.1055/s-0028-1085927
Source: PubMed

ABSTRACT Therapeutic embolization of the gonadal veins is performed on male and female patients for different clinical situations using similar techniques. The testicular varicocele is a common clinical problem associated with pain and reduced fertility rates. In women, chronic pelvic pain can be attributed to pelvic congestion syndrome, which is said to result from retrograde flow in incompetent ovarian veins. Both of these clinical problems respond well to gonadal vein embolization. In this article, we review the clinical evaluation, diagnostic workup, and technical aspects of percutaneous intervention of gonadal vein embolization. The supporting literature is also reviewed.

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    ABSTRACT: Purpose: To effect regression of benign prostatic hyperplasia (BPH), Gat et al. (Andrologia 2008) proposed to occlude incompetent spermatic veins to reduce increased hydrostatic pressure on the prostatic venous plexus and prevent reflux with androgen rich blood from the testicles. Our aim was to implement this treatment strategy in clinical practice and to report about first results. Methods: Embolization of the spermatic veins was performed in 30 patients with BPH. In 16 patients, we obtained follow-up data from at least 6 months. The sonographic transabdominal prostatic volume, prostate-specific antigen (PSA) and peripheral total testosterone levels were determined before and 6 months after the intervention. Subjective symptomatology was assessed using standardized questionnaires (International Prostate Symptom Score [IPSS] and Quality of Life score [QoL]) before and 6 months after the procedure. Results: The age of all treated patients was 46 - 77 years. The age of the 16 patients who received follow-up was 51 - 77 years. IPSS (median 18 [IQR 20.75 - 14.50] vs. 9 [IQR 11.00 - 7.25], p < 0.0001) and QoL score (4 [IQR 5 - 3] vs. 2 [IQR 3 - 1], p < 0.001) were significantly decreased 6 months after the intervention. The subjective improvement of symptoms did not correspond with prostatic volumes, which did not change significantly (54.31 ± 30.90 vs. 50.50 ± 29.26 ml, p = n. s.). 4/16 patients had a measurable post-void urine volume, which decreased in two patients 6 months after the procedure, remained unchanged in one patient, and was no longer detectable in one patient. 4 of the 11 had a sonographically detectable varicocele before the intervention, and one patient had a trabeculated bladder. Both the peripheral total testosterone levels (4.55 ± 1.27 vs. 3.93 ± 1.00 ng/ml; p = n. s.) and PSA levels (3.74 ± 2.83 vs. 4.06 ± 3.34 ng/ml; p = n. s.) showed no significant differences. Conclusion: Interventional occlusion of the spermatic veins in patients with BPH is a feasible outpatient procedure with a low complication rate. Intermediate results are satisfactory. Mid- and long-term results and pathophysiologic mechanisms need to be further elucidated. Key Points: • Venous embolization in patients with BPH is a feasible outpatient procedure.• It shows satisfactory intermediate result with good symptom relief.• Medium and long-term results need to be further evaluated. Citation Format: • Strunk H, Meier M, Schild HH et al. Treatment of Benign Prostatic Hyperplasia by Occlusion of the Impaired Urogenital Venous System - First Experience. Fortschr Röntgenstr 2014; DOI: 10.1055/s-0034-1385353.
    RöFo - Fortschritte auf dem Gebiet der R 11/2014; 187(03). DOI:10.1055/s-0034-1385353 · 1.96 Impact Factor
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    ABSTRACT: To assess the suitability of transvaginal duplex ultrasonography to identify pathological reflux in the ovarian and internal iliac veins in women.
    Phlebology 10/2014; DOI:10.1177/0268355514554638 · 1.92 Impact Factor
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    ABSTRACT: Previous research into pelvic venous reflux has suggested that the size of the ovarian veins indicates the presence or absence of reflux. It is already known that vessel diameter is not an indicator of reflux in the great saphenous vein. However, to this day, physicians still use vein size to plan treatment of refluxing ovarian veins. The authors aimed to investigate whether or not vessel diameter can be used as an indicator of reflux in the ovarian veins. Nineteen female patients (mean 40.2 years, range 29-60) presenting to a specialist vein unit with leg varicose veins underwent duplex ultrasonography (DUS). All were found to have a significant pelvic contribution to their leg reflux on transvaginal duplex ultrasonography (TVS) and were referred to an interventional radiologist for treatment by transjugular coil embolization. During the procedure, the diameter of the ovarian veins was measured using digital subtraction venography. Thirty-four ovarian veins were measured (17 right, 17 left) and of these 18 were found to be non-refluxing while 16 displayed reflux. The mean diameter of the non-refluxing veins was 7.2 mm (range 3-13 mm) and that of the refluxing veins was 8.5 mm (range 4-13 mm). This difference was found to be insignificant at a 95% confidence level (Student t test, p = .204). There is no significant difference between the diameters of competent and refluxing ovarian veins and, as such, techniques that measure vein diameter may not be suitable for the diagnosis of venous reflux in the ovarian veins. Copyright © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
    European Journal of Vascular and Endovascular Surgery 11/2014; 49(1). DOI:10.1016/j.ejvs.2014.10.013 · 3.07 Impact Factor


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