Hollywood, FL (January 25, 2020) – Various types of embolization were discussed during a morning session at the International Symposium on Endovascular Therapy (ISET). Speakers shared best practices for modalities such as uterine artery embolization, prostate artery embolization, and varicocele embolization.
The first speaker, Maureen Kohi, MD, presented on uterine artery embolization and how to use clinical outcomes to determine patient selection. She covered short- and long-term outcomes for uterine artery embolization, the reintervention rate, impact on fertility, and patient selection.
Uterine artery embolization leads to satisfaction rates up to 48% within 24 months after the procedure. It also results in a shorter hospital study for patients, as well as a more rapid return to daily activities. However, there is a higher risk of minor complications after uterine artery embolization, she noted.
Patient selection is important, especially reproductive history, including history of infertility and miscarriages, and desire for future fertility. “Patient selection is key, just like anything else we do in IR,” she concluded.
In another presentation, Lindsay Machan, MD, covered technique and reported outcomes for varicocele embolization. Traditional indications for the procedure are infertility and appropriate semen abnormalities, groin pain, adolescent varicocele, or testicular atrophy. Methods of access for varicocele embolization are jugular, femoral, and antecubital.
Dr. Machan emphasized that liquids such as glue or sclerosant are essential. It is also important to keep liquid out of the scrotum, he noted. Overall, varicocele embolization is the “quintessential minimally invasive procedure,” he said, and has similar, and possibly better, outcomes to open surgery.
Gloria Salazar, MD, discussed when and how to treat pelvic congestion syndrome. She offered a checklist of criteria and also stressed possibilities to rule out, such as endometriosis, fibroids, malignancy, pelvic infection, mass-effect, and neurological diagnosis. She reviewed studies examining treatment and concluded that although there is heterogeneity of studies, proper diagnosis and patient selection is key.
Ovarian vein and internal iliac vein embolization is a minimally invasive, low risk, outpatient treatment, she said, with 70% to 98% of patients experiencing a positive clinical response to treatment. Stenting is also indicated in the setting of pelvic venous disorder but more studies are needed, Dr. Salazar noted, and renal vein compression remains controversial.
A presentation by Jafar Golzarian, MD, covered geniculate artery embolization. It is a technically challenging procedure, and a Swan Neck shape microcatheter is ideal for the superior and inferior genicular arteries.
“Sometimes [geniculate artery embolization] is difficult, and there is a learning curve,” he said. He added, “Make sure you don’t have reflux, because the last thing you want is non-targeted embolization.”
Maureen Kohi, MD, discussed hemorrhoids, first reviewing grade level classification of hemorrhoids and non-surgical options, including lifestyle changes and medication. She then reviewed cases requiring surgical intervention and highlighted the minimally invasive technique of superior rectal artery embolization as an option.
For clinicians who want to offer superior rectal artery embolization, practice building and gaining buy-in from referring clinicians is a major challenge. She recommended reaching out to obstetric and gynecological colleagues since women tend to have more hemorrhoids, and hemorrhoids are often triggered by pregnancy. “Superior rectal artery embolization is safe and effective,” she concluded, though “comparative data are required to evaluate where this treatment option fits in the management of patients with symptomatic hemorrhoids.”
Rahul Patel, MD, closed the session with a presentation on how to use liquid embolics. He summarized the three main types of embolics (adhesive, cohesive, and sclerosant), and he explained how to set up each type of embolic.
Although cost can be prohibitive for everyday use, liquid embolics are effective for many different types of problems. The key to success is identifying the right liquid for the right problem, and liquid embolics “definitely have a learning curve,” he said.