Initial Experience with 3% Sodium Tetradecyl Sulfate Foam and Fibered Coils for Management of Adolescent Varicocele

Reiner, Eric; Pollak, Jeffrey S.; Henderson, Katharine J.; Weiss, Robert M.; White, Robert I.

doi:10.1016/j.jvir.2007.08.013

« Previous Next »Journal of Vascular and Interventional Radiology
Volume 19, Issue 2 , Pages 207-210, February 2008

Initial Experience with 3% Sodium Tetradecyl Sulfate Foam and Fibered Coils for Management of Adolescent Varicocele

Eric Reiner, MD
- Department of Diagnostic Radiology, Section of Interventional Radiology, Yale University School of Medicine, 333 Cedar Street, Room 5039 LMP, New Haven, Connecticut 06520
Jeffrey S. Pollak, MD
- Department of Diagnostic Radiology, Section of Interventional Radiology, Yale University School of Medicine, 333 Cedar Street, Room 5039 LMP, New Haven, Connecticut 06520
Katharine J. Henderson, MS
- Department of Diagnostic Radiology, Section of Interventional Radiology, Yale University School of Medicine, 333 Cedar Street, Room 5039 LMP, New Haven, Connecticut 06520
- K.J.H. and R.I.W. were supported in part by the Josephine Lawrence Hopkins Foundation.
- Address correspondence to K.J.H.
Robert M. Weiss, MD
- Department of Surgery, Section of Urology, Yale University School of Medicine, 333 Cedar Street, Room 5039 LMP, New Haven, Connecticut 06520.
Robert I. White Jr, MD
- Department of Diagnostic Radiology, Section of Interventional Radiology, Yale University School of Medicine, 333 Cedar Street, Room 5039 LMP, New Haven, Connecticut 06520
- K.J.H. and R.I.W. were supported in part by the Josephine Lawrence Hopkins Foundation.

Received 10 January 2007; received in revised form 18 August 2007; accepted 19 August 2007.

Purpose

To report the results of treatment of adolescent patients with varicocele with use of 3% sodium tetradecyl sulfate foam (STS) in combination with pushable fibered coils.

Materials and Methods

From September 2004 to September 2006, 16 adolescent patients (age 12–19 y) with symptomatic varicocele, testicular atrophy, or surgical recurrence underwent embolization with STS foam and coils. The left internal spermatic vein (ISV) was coaxially catheterized from the right femoral vein. Three percent STS foam was placed distally in the ISV during compression so minimal foam entered the pampiniform plexus. A second nest of coils was placed in the ISV at a position over the sacroiliac (SI) joint that occluded most of the parallel collateral vessels. Coils were not placed above the SI joint in most instances. Additional foam was injected in the ISV at the upper level of the SI joint. The upper ISV was left unoccluded. Our standard follow-up consisting of ultrasound and/or physical examination after varicocele occlusion was performed 2–12 months after the procedure.

Results

All occlusions were technically successful, and 15 of 16 patients (94%) exhibited proven disappearance of the varicocele. All patients were asymptomatic except one who had pain despite disappearance of the varicocele. One patient with a bleeding disorder had 48 hours of scrotal discomfort as a result of pampiniform phlebitis caused by the deliberate passage of foam into the pampiniform plexus.

Conclusions

The use of 3% STS foam in combination with pushable fibered coils is a safe and effective sclerosing procedure for adolescent subjects with varicocele.

Abbreviations: DSB, detachable silicone balloon, ISV, internal spermatic vein, SI, sacroiliac, STS, sodium tetradecyl sulfate