Endovenous laser ablation of spermatic vein for the treatment of varicocele

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1 Endovenous laser ablation of spermatic vein for the treatment of varicocele Poster No.: C-22 Congress: ECR 207 Type: Scientific Exhibit Authors: A. Motta, G. Caltabiano, M. Pizzarelli, G. Failla, S. Palmucci, C. Gozzo, F. Arena, A. Basile ; Catania/IT, CATANIA (CT)/IT, /IT Keywords: Genital / Reproductive system male, Interventional vascular, Veins / Vena cava, Catheter venography, Ultrasound-Colour Doppler, Percutaneous, Laser, Embolisation, Venous access, Varices, Sedation, Outcomes DOI: 0.594/ecr207/C-22 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page of 8

2 Aims and objectives Current treatment of varicocele involves both surgical (open, laparoscopic and microsurgery) and interventional approach (either with coils and/or sclerosant injection). Moreover percutaneous embolisation of the spermatic veins for treatment of varicocele represents a less invasive and effective alternative to surgery [,2]. This study was designed to demonstrate the feasibility and the reliability of endovenous laser ablation (EVLA) of the spermatic vein for the treatment of varicocele. EVLA has been first introduced in the treatment of venous insufficiency; more specifically from modern literature we would find practice of this technique for treatment of varicose veins usually long saphenous vein and short saphenous vein (both above and below the knee) with good results compared to ligation, phlebectomies and stripping [3,4]. EVLA is known for overcoming complications related to sclerosant injection (SIR); it would also be able to avoid complications derived by the use of coils, such as migration and /or allergies [2,5,6,7]. Just one abstract from 203 by Chamsuddin et al. reported efficacy of the EVLA in the treatment of both male varicocele and female pelvic congestion syndrome, authors did mention their cases where treated with coils and/or foam sclerosant along EVLA [8]. We present a first report on the use of EVLA to occlude the left spermatic vein in patients with left testicular varicocele. Methods and materials We treated patients (age range years old, mean 3y) with left varicocele, phlebografically classified as Bahren type I and with indication for percutaneous treatment. Access was achieved through the right basilic vein in nine cases and through the right common femoral vein in two cases. Both veins were cannulated under ultrasound guidance and a 5 french MPA or Cobra C2 shaped catheter was easily advanced on a 0,035' hydrophilic wire. Once the left spermatic vein was cannulated, a radial 470nm laser fiber was inserted coaxially into a 5 french 70 or 90cm long sheet till the distal portion of the vein (shown in figure n and n 2). Due to the fact that the tip of the fiber didn't present any radiopaque marker, we tested the length of the fiber inside the sheet in order to expose three cm outside its tip. According to the manufacturer protocol, we applied an energy/cm between 40-50J at 5 watt (power), in continuous wave fashion in three different locations of the left spermatic vein below L3. The procedure was performed with patients under conscious sedation, in outpatient fashion. Total occlusion of the spermatic vein at venographic control was considered as technical success (Figure n 3). Clinical success was evaluated by color doppler ultrasound (CDUS) one week, one months and three months after the procedures. We also evaluated the pain feeling for 48 hours after the procedure. Page 2 of 8

3 Images for this section: Page 3 of 8

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5 Fig. : a) the laser fiber coaxially inserted into the vascular sheet, with the active tip outside (b) Prof. A. Basile Page 5 of 8

6 Fig. 2: c) the distal portion of the laser fiber not opacified during phlebography due to absence of radiopaque markers Prof. A. Basile Fig. 3: A) Phebography showing the distal portion of the left spermatic vein; B) postprocedure control showing the occlusion of the left spermatic vein Prof. A. Basile Page 6 of 8

7 Results Technical success was achieved in all cases. In all cases varicocele disappeared at CDUS at and three months with reflux abolition. Two cases of small vein laceration were noted without sequelae, no other complication has been described. All patients reported improvements either regarding symptoms and/or spermiographic parameters. We believe there is no need for concomitant use of spirals and/or sclerosant. Conclusion In our experience, EVLA of spermatic vein is a feasible and safe treatment in patients with Bahren type I varicocele. There would be room for improvement with a dedicated endovascular laser fiber and an operative protocol in agreement with manufacturers. We believe that a long term comparison with other available techniques would provide more glances regarding our approach to vein's care, particularly varicocele. Personal information References. Porst H, Bahren W, Lenz M et al (984) Percutaneous sclerotherapy of varicoceles-an alternative to conventional surgical methods. Br J Urol 56: Iaccarino V, Venetucci P (202) Interventional radiology of male varicocele: current status. Cardiovasc Interv Radiol 35: Chwa#a M, Szczeklik W, Szczeklik M, Aleksiejew-Kleszczy#ski T, Jagielska-Chwa#a M. Varicose Veins of Lower Extremities, Hemodynamics and Treatment Methods Adv Clin Exp Med 205, 24,, L.Navarro, R.J.Min, C.Boné, Endovenous laser: a new minimally invasive method of treatment for varicose veins - preliminary observations using an 80nm diode laser, Dermatol.Surg.27(2)(200)7-22. Page 7 of 8

8 5. Tessari L, Cavezzi A, Frullini A (200) Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg 27: Forlee MV, Grouden M, Moore DJ, Shanik G. Stroke after varicose vein foam injection sclerotherapy. J Vasc Surg Jan;43(): Bruijninckx CM. Fatal pulmonary embolism following ultrasound-guided foam sclerotherapy combined with multiple microphlebectomies. Phlebology. 205 Sep A. Chamsuddin, R. Achou, Endovascular laser venous ablation for treatment of spermatic and ovarian venous insufficiency in male varicocele and female pelvic congestion syndrome, Journal of Vascular and Interventional Radiology, Volume 24, Issue 4, Page S79 Page 8 of 8