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Spermatic vein occlusion with hot contrast material: angiographic results
D W Hunter1, N J King, D M Aeppli
1Department of Diagnostic Radiology, University of Minnesota Hospital and Clinic, Minneapolis 55455.
Insights
Spermatic vein occlusion using hot contrast material effectively treated varicoceles in men. This minimally invasive procedure achieved high occlusion rates, offering a promising solution for varicocele-related symptoms and infertility.
Area of Science:
- Interventional Radiology
- Urology
- Vascular Surgery
Background:
- Varicoceles are a common cause of male infertility and scrotal pain.
- Traditional surgical interventions carry risks and potential complications.
Purpose of the Study:
- To evaluate the efficacy and safety of selective spermatic vein occlusion using boiling contrast material.
- To assess the occlusion rates and clinical outcomes in men with symptomatic varicoceles.
Main Methods:
- 175 men with symptomatic varicoceles underwent selective spermatic vein occlusion via injection of boiling contrast material.
- Follow-up venography was performed to assess vein patency and occlusion rates.
- Treatment outcomes were categorized based on radiographic assessment of the treated spermatic vein.
Main Results:
- Overall occlusion rate was 83%, increasing to 91% with modified technique (larger volumes).
- 16% of treated veins remained patent, with failures categorized into three grades.
- Pretreatment spermatic vein size and injected contrast volume significantly impacted treatment success.
Conclusions:
- Selective spermatic vein occlusion with hot contrast material is an effective treatment for varicoceles.
- The technique demonstrates high occlusion rates and offers a viable alternative to surgery.
- Optimizing injected volume and considering vein size are crucial for successful outcomes.
Abstract:
Spermatic vein occlusion by means of selective injection of boiling contrast material into the spermatic vein was attempted in 175 men with symptomatic varicoceles or infertility. Seventy-six patients (43%) returned for follow-up venography. Of 115 veins injected, 96 (83%) were totally occluded on the follow-up venogram obtained at 6 weeks to 2 years after injection. In the latter portion of the study, the technique was changed slightly, with injection of larger volumes of hot contrast material, resulting in a 91% occlusion rate. Each vein that was found patent on the follow-up venogram (19 of 115 [16%]) was assessed radiographically, and results were categorized as grade 1, a complete failure in which there was no change from the presclerotherapy appearance (nine of 19 [47%]); grade 2, a failure in which the treated vein was smaller but patent (five of 19 [26%]); or grade 3, a failure in which the treated vein was occluded with newly developed collateral vessels (five of 19 [26%]). The pretreatment size of the spermatic vein and the quantity of hot contrast material injected were both statistically significant factors in the treatment outcome.