GEST 2018 Abstract: Novel “Uncoil Coil” Technique for Varicocele Embolization

Written by
Michael Cumming, MD, MBA

Novel “Uncoil Coil” Technique for Varicocele Embolization

Nassir Rostambeigi, MD, MPH

Greg Allen, PA-C, MPAS

Nathan Braun, RPA

Jafar Golzarian, MD

Michael Cumming, MD, MBA

 

PURPOSE:

We evaluated safety and efficacy of a novel varicocele embolization technique, the “uncoil coil” technique, which uses oversized coils deployed by uncovering the coil versus the traditional coil packing.

MATERIALS AND METHODS:

Twenty-two consecutive patients underwent embolization of the testicular vein utilizing the “uncoil coil” technique. Testicular vein embolization was performed utilizing sodium tetradecyl sulfate foam 3% distally followed by coil embolization of the remainder of the testicular vein utilizing large diameter (15-20 mm) 15 cm long platinum coils. Coils were deployed by advancing the coil through a catheter to the desired location and deploying the coil by withdrawing the delivery catheter over the pusher wire, simply uncovering the coil without packing it in place. All procedures were performed by a single experienced interventionalist. Twenty-five traditional coil packing procedures by same operator were evaluated for comparison retrospectively.

RESULTS:

Twenty-four procedures were performed on 22 patients (2 patients required a second attempt after CT venography to identify the testicular vein). Fifty percent had previous varicocelectomy. Indications were pain (12), infertility (7), and both (3). Eleven patients underwent bilateral embolization, 12 left sided embolization. Technical success 100% including second attempts. Mean of 2.5 coils per side embolized, mean fluoroscopy 351 seconds. Traditional coil packing utilized a mean of 4.7 coils per side embolized with mean fluoroscopy 450 seconds. Significant difference in coil use with independent t-test results of t(45)=6.96, p<.05.  No significant difference in fluoroscopy times.

Twenty-one of 22 patients (33 of 34 embolized veins) had clinical and ultrasound follow up at a mean of 6 weeks (range 2-21 weeks). Complete elimination of the varicocele in 100% of right sided and 83% of left sided embolization. Four left sided embolizations showed reduction in the size of the varicocele on ultrasound, but demonstrated some residual reflux. Three of these 4 patients’ presentation was pain. Two has complete pain relief, and 1 had partial pain relief. Of all the 15 patients treated for pain (8 bilateral, 7 left), 12 reported complete relief and 3 reported partial relief. No short-term complications occurred within the follow-up period.

CONCLUSION:

The “uncoil coil” is an efficacious and safe technique resulting in varicocele elimination, symptom improvement, and reduction in coil use.

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