It is estimated that 39% of U.S. women suffer from chronic pelvic pain which maybe accompanied by dyspareunia, i.e., pain during or following intercourse. For10% of women of child-bearing age, the cause is pelvic congestion syndrome. This condition is due to incompetent valves within the left and right gonadal veins leading to the development of pelvic varicose veins. MR venography and transvaginal color Doppler ultrasound imaging are frequently used to make the diagnosis. This condition can be successfully treated with outpatient gonadal vein embolization.
Approximately 10% of American males and 30% of males in infertile couples are estimated to suffer from varicocele, a condition caused by incompetent valves in the internal spermatic veins (ISVs), usually on the left, that leads to reflux of blood within the ISVs and the development of scrotal varicose veins. This causes scrotal discomfort as well as abnormally low sperm counts and motility. Unfortunately, 95% of varicoceles are still treated by painful open urologic surgery, frequently accompanied by recurrence of the varicocele. Fortunately, outpatient trans catheter ISV embolization effectively treats scrotal varicose veins and can lead to improvement in sperm count and motility in the vast majority of patients.
Uterine fibroids, which occur in a significant proportion of the U.S. female population and up to 45% of African-American females, can cause significant pain, urinary symptoms, infertility and anemia due to heavy periods. Uterine artery embolization (UAE) is far less painful and debilitating than hysterectomy and myomectomy. UAE has been shown to be superior to myomectomy for fertility enhancement and relief of symptoms. Within a week following UAE, women are usually able to return to work and their other usual activities. The vast majority of women can expect signicant improvement in their symptoms. Although most patients will remain in the hospital overnight following the embolization, many women can tolerate this procedure on an outpatient basis. UAE is accepted by the American College of Obstetrics and Gynecology as a viable alternative treatment for uterine fibroids. It is typically covered by most health insurance plans.
Chronic subdural hematomas are blood collections that accumulate between the dural layer and subarachnoid matter surrounding the brain. These blood collections can grow over time causing compression of the adjacent brain resulting in neurologic damage, coma and even death, if severe enough. This condition affects roughly 200,000 Americans annually. Although they may be due to trauma, they can also occur spontaneously or in association with the use of blood-thinners and with advancing age. Typically, invasive neurosurgical drainage and sometimes use of steroids have been used to eliminate these hemorrhages. However, the blood collection can re-accumulate in over a quarter of neurosurgical patients, and use of steroids can lead to weakened bones as well as other complications.
In patients who do not require in-hospital care, chronic subdural hematomas can be obliterated by injecting tiny particles (embolization) into the middle meningeal artery near the skull base under local anesthesia and moderate intravenous sedation. This outpatient procedure is usually quick and painless. You will need to remain supine for about two hours after the procedure. A follow-up brain CT obtained in about 2 months may definitely demonstrate partial or complete resolution of the subdural hemorrhage.