No open license is recorded for this paper. Reuse terms are set by the publisher.
Abstract
Background
Embolization is an established treatment for varicocele. Coils are most frequently used in the procedure. Liquid embolic and sclerosing agents seem to have a number of advantages over coils.
Purpose
To report our experience and explain the technique of using N-2-butyl-cyanoacrylate (N2BCA) in varicocele treatment.
Materials and Methods
From January 2010 to July 2011, 42 gonadal veins in 41 consecutive patients (age range, 11-41 years; mean, 18 years) with a diagnosis of varicocele were treated with N2BCA as an embolic agent. The clinical diagnosis was confirmed by Doppler ultrasound in all patients. Institutional review board approval was obtained, and all the patients signed informed consent for this retrospective review. In all cases, a 4-F hydrophilic catheter was used to catheterize the distal portion of the gonadal vein through which N2BCA, emulsified with lipiodol, was injected.
Results
The technical success was 100%. No complications or non-targeted embolizations were reported. Seven patients reported moderate post-embolization pain that required oral analgesic treatment for 7-10 days. After 12-month follow-up, all patients exhibited varicocele resolution in the Doppler ultrasound examination as well as relief of all previous symptoms. We have no fertility-related data for patients treated for this condition.
Conclusion
N2BCA as an embolic agent is a therapeutic alternative for the endovascular treatment of varicocele. This technique is uncomplicated, inexpensive, efficient, and safe.
Hipola JM et al., 2026·Journal of vascular surgery. Venous and lymphatic disorders·Free full text on PubMed Central
To report feasibility, safety, and clinical outcomes of direct transvaginal ultrasound (TVUS)-guided foam sclerotherapy for isolated periuterine/pericervical varices or residual venous reservoirs after prior embolization.
Prospective single-center observational cohort including consecutive women (January 2023-October 2025) meeting predefined inclusion and exclusion criteria. Procedures were performed under general anesthesia using ultrasound-guided transvaginal venous puncture with fluoroscopic confirmation. Low-nitrogen 3% polidocanol foam was injected directly into the targeted periuterine and pericervical venous plexuses until complete filling of the treated reservoirs was achieved. Primary end points were technical success and changes in the Pelvic Venous Clinical Severity Score (PVCSS) and Pelvic Varicose Vein Questionnaire (PVVQ) score at 1 month and 1 year. Normality was evaluated with the Shapiro-Wilk test, repeated-measures analysis of variance with Mauchly's test for sphericity, and Tukey's honestly significant difference for pairwise comparisons (α = 0.05). Institutional review board approval was obtained, and informed consent was required.
Twenty-three patients (mean age, 40.5 years) underwent treatment; 74% had a history of prior gonadal vein embolization and presented with persistent symptoms at inclusion, whereas 26% had no prior embolization and presented with isolated periuterine or pericervical varices without axial reflux. Technical success was 100%. The mean procedural time was 36.0 ± 12.5 minutes, and the mean fluoroscopy time was approximately 1 minute. The mean sclerosant volume was 18.5 ± 5.3 mL. Radiation exposure remained low, with a mean dose-area product of 1.945 ± 0.347 Gy cm2 and a mean absorbed dose of 72.0 ± 3.1 mGy. All patients were discharged the same day and resumed normal activities the following day. Minor vaginal bleeding occurred in 82% the day after treatment; no menstrual disturbances were reported. TVUS follow-up showed complete closure of the treated periuterine and pericervical venous plexuses, without evidence of recanalization in any patient at follow-up. The PVCSS improved from 12.91 at baseline to 7.87 (1 month) and 7.96 (1 year); the PVVQ score improved from 75.97 to 46.12 and 50.32, respectively. Overall improvement was significant (P < .001). Tukey's honestly significant difference confirmed decreases from baseline to 1 month and 1 year for both scales (PVCSS, P < .001; PVVQ, P < .003); the 1-month vs 1-year differences were not significant (PVCSS, P = .987; PVVQ, P = .094).
Direct TVUS-guided 3% polidocanol foam sclerotherapy achieved high technical success, as well as significant and durable symptom improvement at 1 year in this small, highly selected cohort, with no major complications or recanalization. The technique offers a minimally invasive, targeted option for periuterine and pericervical venous reservoirs, particularly in cases not amenable to conventional endovascular access.
Alonso-Burgos A et al., 2024·CVIR endovascular·Free full text on PubMed Central
Postpartum haemorrhage (PPH) is a significant cause of maternal mortality globally, necessitating prompt and efficient management. This review provides a comprehensive exploration of endovascular treatment dimensions for both primary and secondary PPH, with a focus on uterine atony, trauma, placenta accreta spectrum (PAS), and retained products of conception (RPOC). Primary PPH, occurring within 24 h, often results from uterine atony in 70% of causes, but also from trauma, or PAS. Uterine atony involves inadequate myometrial contraction, addressed through uterine massage, oxytocin, and, if needed, mechanical modalities like balloon tamponade. Trauma-related PPH may stem from perineal injuries or pseudoaneurysm rupture, while PAS involves abnormal placental adherence. PAS demands early detection due to associated life-threatening bleeding during delivery. Secondary PPH, occurring within 24 h to 6 weeks postpartum, frequently arises from RPOC. Medical management may include uterine contraction drugs and hemostatic agents, but invasive procedures like dilation and curettage (D&C) or hysteroscopic resection may be required.Imaging assessments, particularly through ultrasound (US), play a crucial role in the diagnosis and treatment planning of postpartum haemorrhage (PPH), except for uterine atony, where imaging techniques prove to be of limited utility in its management. Computed tomography play an important role in evaluation of trauma related PPH cases and MRI is essential in diagnosing and treatment planning of PAS and RPOC.Uterine artery embolization (UAE) has become a standard intervention for refractory PPH, offering a rapid, effective, and safe alternative to surgery with a success rate exceeding 85% (Rand T. et al. CVIR Endovasc 3:1-12, 2020). The technical approach involves non-selective uterine artery embolization with resorbable gelatine sponge (GS) in semi-liquid or torpedo presentation as the most extended embolic or calibrated microspheres. Selective embolization is warranted in cases with identifiable bleeding points or RPOC with AVM-like angiographic patterns and liquid embolics could be a good option in this scenario. UAE in PAS requires a tailored approach, considering the degree of placental invasion. A thorough understanding of female pelvis vascular anatomy and collateral pathways is essential for accurate and safe UAE.In conclusion, integrating interventional radiology techniques into clinical guidelines for primary and secondary PPH management and co-working during labour is crucial.
Royo P et al., 2008·Journal of medical case reports·Free full text on PubMed Central
Postpartum ovarian vein thrombosis is an uncommon complication; incidence varies between 0.002% and 0.05%. It most often occurs during the 2-15 days following delivery.
A 22-year-old pregnant woman at term presented to hospital with uterine contractions, abdominal pain, nausea and vomiting. After delivery an ovarian vein thrombosis was diagnosed.
Low-molecular weight heparin with broad-spectrum antibiotics are the accepted therapy in non-complicated cases of postpartum ovarian vein thrombosis.
José Urbano, Manuel Cabrera, Alberto Alonso-Burgos
J Urbano, M Cabrera, A Alonso-Burgos
PMID 23888063 23888063 DOI 10.1177/0284185113493774 10.1177/0284185113493774 Urbano et al. 2014, Urbano 2014