title: Left spermatic vein retrograde sclerosis: comparison between sclerosant agent injection through a diagnostic catheter versus through an occluding balloon catheter.
abstract: OBJECTIVE
  The aim of this study was to compare the technical success between left spermatic vein (LSV) scleroembolisation achieved with the injection of sclerosant through a diagnostic catheter and through an occluding balloon (OB), in the treatment of male varicocele.
  
  
  METHODS
  From January 2012 to September 2013, we prospectively enrolled 100 patients with left varicocele and an indication for LSV scleroembolisation related to symptoms or spermiogram anomalies; patients were randomised to two groups (we wrote a list of 100 lines assigned casually with A or B and each patient was consecutively allocated to group A or B on the basis of this list). Patients in group A underwent injection of the sclerosing agent through an angiographic diagnostic catheter (free catheter technique) and patients in group B through an OB catheter (OB technique). In cases of incomplete occlusion of the LSV, the procedure was completed with coils. Total occlusion of the LSV at post-treatment phlebography during a Valsalva manoeuvre before any coil embolisation was considered a technical success. The rate of complications was also evaluated. The Fischer's test was used for statistical analysis.
  
  
  RESULTS
  We evaluated a total of 90 patients because five patients for each group were not included in the statistical analysis owing to technical problems or complications. In group A we had a technical success of 75.6 versus 93.4 % in group B, and the difference was statistically significant (P = 0.003); in particular, we had to complete the embolisation with insertion of coils in 11 cases (24.4 %) in group A, and in three cases in group B (6.6 %). In group A, LSV rupture occurred in four cases (8 %) so the procedure was completed by sclerosant injection through the OB located distally to the lesion. These patients were not considered for evaluation. In another case, a high flow shunt towards the inferior vena cava was detected, so the patient underwent OB injection to stop the flow to the shunt, and was not included for statistical evaluation. In group B, vein rupture with contrast leakage was noted in six cases (12 %); nonetheless, all the procedures were completed because the OB was positioned distally to the vessel tear, obviating any retrograde leakage of sclerosant. In group B, in five cases (10 %), we were unable to advance the OB though the LSV ostium so the procedures were completed with the diagnostic catheter and not considered for statistical evaluation.
  
  
  CONCLUSIONS
  On the basis of our data, the embolisation of the LSV obtained by injecting the sclerosant through an OB rather than through a diagnostic catheter seems to be more effective in achieving total vein embolisation, as well as allowing a controlled injection of sclerosant even in cases of vein rupture.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Garibaldi Centro Hospital, Piazza Santa, Maria Del Gesù, Catania, 95124, Italy, antodoc@yahoo.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Basile
authors.forename: Giovanni
authors.initials: G
authors.lastname: Failla
authors.forename: Sandro
authors.initials: S
authors.lastname: La Vignera
authors.forename: Rosita Angela
authors.initials: RA
authors.lastname: Condorelli
authors.forename: Aldo
authors.initials: A
authors.lastname: Calogero
authors.forename: Enzo
authors.initials: E
authors.lastname: Vicari
authors.forename: Antonio
authors.initials: A
authors.lastname: Granata
authors.forename: Elena
authors.initials: E
authors.lastname: Mundo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caltabiano
authors.forename: Marco
authors.initials: M
authors.lastname: Pizzarelli
authors.forename: Martina
authors.initials: M
authors.lastname: Messina
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scavone
authors.forename: Franz
authors.initials: F
authors.lastname: Lanzafame
authors.forename: Roberto
authors.initials: R
authors.lastname: Iezzi
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsetis
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography; D021721:Balloon Occlusion / Q000295:instrumentation*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015911:Sclerotherapy / Q000379:methods*; D016896:Treatment Outcome; D014646:Varicocele / Q000628:therapy*
chemical_list: D012597:Sclerosing Solutions