By: Jean Johnson for Veins1“This simple and elegant embolization technique allows us to treat testicular atrophy in young boys, reverse infertility in some men and relieve debilitating pain in women – all non-surgically,” said Robert White, Jr., M.D., interventional radiologist at the Yale-New Haven Hospital. White presented results of research at the Society of Interventional Radiology’s 31st Annual Scientific Meeting in Toronto, in March.
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Observations from the Society of Interventional Radiology:
As many as 80,000 men in America may undergo surgical correction of varicocele annually. “Surgery is still the most common treatment in the U.S. because patients aren’t aware that they have choices,” said Robert White, M.D., Yale University School of Medicine.
Up to 15 percent of women, generally between the ages of 20 and 50, have varicose veins in the pelvis, although not all experience symptoms.
Chronic pelvic pain accounts for 15 percent of outpatient gynecologic visits.
Studies show 30 percent of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) along with another pelvic pathology.
There is an average of one to two days for complete recovery with embolization, including physical activity. Surgery, on the other hand has a two to three weeks recovery time, with another two to three weeks until the patient can return to full exercise, such as jogging.
The interventional radiology embolization treatment is much less painful than surgery and does not have the risks associated with general anesthesia.
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If White sounds enthusiastic it’s because he has been at the forefront of treatment for varicocele – a common cause of pain and infertility in men – since 1978 when he co-invented the original varicocele embolization treatment with urologist Patrick Walsh, M.D. Testicular Varicose Vein (Varicocele) Causes Pain
According to the Society of Interventional Radiology (SIR), “a varicocele is a varicose vein of the testicle and scrotum that may cause pain, testicular atrophy (shrinkage) or fertility problems.”
SIR also explains that “Veins contain one-way valves that work to allow blood to flow against gravity from the testicles and scrotum back to the heart. When these valves fail, the blood pools and enlarges the veins around the testicle in the scrotum to cause a varicocele.”
Varicocele can also rise from the absence of valves in a vein. In the case of infertility, the spermatic vein would be the affected area.
“For years we have used image-guided outpatient treatment for varicocele, a common cause of pain and infertility in men,” White said, who is also professor of diagnostic radiology at Yale University’s School of Medicine and director of the Yale-New Haven Hospital’s vascular malformation center.
“Varicocele is a standard interventional radiology treatment that is widely available across the country. No incision is made. No general anesthesia is used. No scars are left behind. When we are done, the patient leaves with only a band-aid,” White said.
Original Varicocele Treatment Used Dacron Filaments Only
The SIR adds that in the “standard embolization procedure, an interventional radiologist makes a nick in the skin to access the femoral vein, then uses X-rays to guide a catheter up the femoral vein and into the faulty vein. Then small coils are releases to block the vein. The coils have Dacron filaments that allow clots to form of the coil, helping to seal shut the faulty vein in addition to the mechanical occlusion.”
While this procedure helped numerous patients, and enjoyed a 90 percent success rate over the 25 plus years since its inception in 1978, the coils only work in the larger areas of the faulty vein.
New Research Employs Foam Agent Sotradecol
By adding sotradecol – a foam agent only available in the United States since 2004 – when they place the coil, interventional radiologists are able to block the smaller sections of the varicocele, or varicose vein, along with the smallest associated collateral veins.
In the trial study out of Yale University, White and his colleagues treated 16 patients suffering from varicocele – six adults and 10 adolescents. After this treatment, now 15 of the 16 participants no longer have pain.
The team also treated eight female patients suffering from pelvic congestion syndrome caused by varicose veins in the pelvis. All of the women experiencing this chronic debilitating condition showed improvement, with half of the group showing “marked improvement,” according to a Yale-New Haven Hospital new release.
Women Suffering Needlessly, Says Yale’s Robert White, M.D.
Women who undergo embolization enjoy the same benefits, but the varicose veins that cause their problems are not as easily diagnosed or treated. Still, White says embolization via interventional radiology has much to offer, and that the new developments with the foam agent sotradecol make the technique all the more promising.
“Most women I have treated have spent years looking for a solution to their chronic pelvic pain – suffering needlessly because they aren’t aware interventional radiologists have a treatment. We are vascular experts that can help determine the cause of chronic pelvic pain, and treat it if it has a vascular origin,” said White.
“This new, enhanced image-guided procedure has shown to be effective in treating both pelvic pain and testicular pain,” White said.
Testicular Atrophy in Young Boys
Varicocele is also a common cause of testicular atrophy in adolescent boys.
“If only my youngest brother had a chance at this new technique when he was a teen,” said Mary Ella Brown of Seattle. “The way my mother always told it, one of his testicles never descended – so I’m not sure if he had a varicocele or not. But I suppose the point is academic since that was back in the1960s.
“Still as far as his life went, I could tell his problems with his testicle affected his self-image. Poor guy. His older brothers were so outgoing and there he was with his masculinity threatened. All that stripping down and showering they forced kids in high school to endure back then. It was wretched for him.
“He never complained of pain, though – at least that I heard about,” Brown continued, “but later on after he married, he and his wife never were able to have children. That I know – it was so sad. They wanted a family so.”
Brown sighs and brushes tears away. “But I guess it was meant to be. He died early – not even 50. So she would have been left to manage alone.
“He was such a gentle, sweet man – I know he if were here today and heard the news, he’d just be glad that others are finally getting some help with things we barely mentioned back when he was young,” said Brown.
Future of New Technique Could Be Major Advancement
“With the addition of sotradecol foam, we are hopeful we can improve on the cure of varicocele and reduce the number of pelvic congestion syndrome,” said White. “If others find similar results as they begin to duplicate this new approach, this will represent a major advancement in the interventional radiological treatment of varicocele and pelvic congestion.”
