Suprapubic percutaneous sclero-embolization of symptomatic female pelvic varicocele under local anesthesia

A. Tinelli1, R. Prudenzano2, M. Torsello2, A. Malvasi3, G. De Nunzio4, I. De Mitri5, M. Bochicchio6, D.A. Tsin7, P. Krishnan8, J.M. Wiley8

1 Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce (Italy)

2 Department of Radiology, Vito Fazzi Hospital, Lecce (Italy)

3 Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari (Italy)

4 Department of Materials Science, University of Salento, and INFN, Lecce (Italy)

5 Department of Physics, University of Salento, and INFN, Lecce (Italy)

6 SET-Lab, Department of Innovation Engineering, University of Lecce (Italy)

7 Division of Gynecological Endoscopy and Minimally Invasive Treatment, Department of Obstetrics and Gynecology, The Mount Sinai Hospital of Queens, Astoria, New York, N.Y. (USA)

8 Mount Sinai School of Medicine, Endovascular Interventions, Cardiovascular Institute Mount Sinai Medical Center, New York, N.Y. (USA)

 

---

• Gynecology

Abstract. – Purpose: To evaluate the safety and feasibility of supra-pubic percutaneous sclero-embolization (SE) in the treatment of symptomatic female pelvic varicocele (FPV), performed under local anesthesia.

Materials and Methods: The authors selected 28 patients screened by transabdominal and transvaginal ultrasound, with venous Doppler signal. Clinicians performed SE by transfemoral catheterization, under local anesthesia, using of a mix of 2 ml of lauromacrogol 400 (Atossisclerol 3%, Chemische F. Kreussler, Wiesbaden, Germany) and 2 ml of air, in a mixed foam fashion.

Results: The total operative time for SE was 7.6±2.1 min. Intra-surgical blood loss was 40±14 ml. No migration of sclerosant material occurred and postoperative analgesic request during a 48 hr period occurred in 6 patients. Technical success was 100%. The authors embolized 8 women bilaterally (28.5%), 18 on the left ovarian vein (OV) (64.2%) and 2 only in the right OV (7.1%): 7 women complained of transitory flank pain (25%), which disappeared in few minutes. The major complications in 10 days after SE were: fever ( >38°C for two days) in 2 patients (7.1%) and pelvic pain for 3 days in eight patients (28.5%). After 30 days only 6 women suffered of FPV lower symptoms which disappeared in 180 days. A substantial reduction in size of pelvic varicosities was noted in all patients.

Conclusions: SE is a safe and feasible procedure. It reduces significantly the mean time of scopies, the intensity of radiation emission, and it is performed under local anaesthesia. This minimally invasive procedure could be proposed to all women with supra-pubic FPV for its reproducibility and feasibility.

Corresponding Author: Andrea Tinelli, MD; e-mail: andreatinelli@gmail.com

 

Free PDF Download