Treatment of Symptomatic High-Flow Female Varicoceles with Stop-flow Foam Sclerotherapy

To assess the efficacy of stop-flow foam sclerotherapy (SFFS) in high-flow pelvic varicoceles using 3 % sodium tetradecyl sulfate (STS) foam. Our institutional review board granted approval and waived informed consent for this retrospective study of 26 patients (mean age 37.3 years, range 23-46 years) with pelvic congestion syndrome (PCS) who had high-outflow venous collaterals treated by SFFS between June 2005 and June 2011 in our department. PCS was diagnosed by physical and transvaginal color Doppler ultrasound examination, while high-outflow venous collaterals were detected at selective ovarian venography. SFFS was performed by injection of 3 % STS foam into the pelvic varices after balloon occlusion of the major venous vessels (hypogastric and/or ovarian veins) to which the high-outflow venous collaterals were tributary. Follow-up was performed at 1, 3, 6, and 12 months by physical and transvaginal color Doppler ultrasound examination and by a questionnaire-based assessment of pain using a symptom severity score. The procedure was technically successful in all patients. After the injection of 3 % STS foam, all patients had a colic like pain that spontaneously resolved after 5 min. During follow-up, no recurrences of PCS were detected. Significant improvement of symptoms (Student's t test P < 0.01) was observed at 1, 3, 6, and 12 months. SFFS using 3 % STS foam is a safe and effective treatment for high-flow female varicoceles and should be considered as an alternative to other endovascular and surgical options.