David's Story: Varicoceles in Young Men

In June of 2014, 19 year old David began feeling discomfort and heaviness in his left testicle. He had no idea what was causing the discomfort and thought that resting and icing it would help but there was no relief. When he noticed that the testicle began to swell, this gave him reason for concern.

David first consulted with a urologist about his discomfort and was sent for a testicular ultrasound that confirmed he had a varicocele in his left testicle. Varicoceles are a tangled network of blood vessels or swelling of the veins on the testicles. It is similar to varicose veins in the legs but in this condition a vein called the gonadal vein has weak, defective valves, resulting in the blood pooling in varicose veins in the scrotum.

A varicocele is a relatively common condition (affecting approximately 10% of men) that tends to occur in young men, usually in their 20s or 30s, but can also develop in younger men and adolescents. In fact, varicoceles develop in 17% of boys between the ages of 13 – 25. Varicoceles are also known to cause infertility issues.

The urologist suggested David undergo a surgical treatment, varicocele surgical ligation. This procedure involves an open incision above the scrotum, general anesthesia, and 2 to 3 weeks of down time. David was willing to try anything to relieve himself even it if meant going under anesthesia, but he did some research on the internet and came across Dr. William Julien an expert endovascular surgeon at South Florida Vascular Associates who performs a procedure called varicocele embolization (VE). VE is a minimally invasive outpatient procedure that requires only a tiny cut in the skin, "twilight" sedation, and almost no downtime. This sounded like a much better option.

Dr. William Julien Explains Varicocele Embolization (VE)

Upon examination, Dr. Julien explained the embolization procedure in depth and also told David that the procedure only takes 30 minutes and he could go home a few hours later with only a small bandage at the puncture site. In addition, he would be able to immediately resume non-exertional activities. Of course, David opted to go with varicocele embolization.

“David had VE on June 24, 2015, and the surgery was a huge success.  “I was not in much pain after the surgery and within 10 days post-surgery, I was pain free”, said David. It took a couple of weeks before the swelling went down but for the most part he was feeling on top of the world! The embolization procedure was David’s first surgery and he was nervous but the surgery was quick and easy. David says the staff was wonderful making sure I was comfortable all the way through and Dr. Julien was awesome, he explained everything to me and eased my concerns. I was also extremely pleased with the care that I received from the time I arrived until they let me go home. David says, it’s so important to educate yourself and know your options before undergoing surgery. Until he learned of varicocele embolization he was ready to go through a painful surgery and long recovery time. I’m so happy that I pursued other options and found the right procedure for me. I feel great, says David and it was so easy!

New Study Shows Endovascular Repair of Abdominal Aortic Aneurysm is Safe, More Improved and Patients Recover Faster

Nearly 40,000 Americans undergo elective surgery per year to repair an abdominal aortic aneurysm (AAA) with the goal of preventing a life-threatening rupture. A new study from researchers at Beth Israel Deaconess Medical Center compared open surgical repair of AAA with a catheter-based procedure and found that the less invasive endovascular aortic repair (EVAR) has clear benefits for most patients, providing both a safer operation and a quicker recovery. The study was published July 22 in The New England Journal of Medicine.

An aneurysm occurs when a blood vessel becomes abnormally large or balloons outward. The abdominal aorta is a large blood vessel that supplies blood to your abdomen, the pelvis, and legs. When a weak area of the abdominal aorta grows, it is called an abdominal aortic aneurysm (AAA).  AAA can develop in anyone, but it is primarily seen in men over 60 with one or more risk factors. The larger the aneurysm, the more likely it is to rupture which can cause massive internal bleeding and can be fatal. When diagnosed early, abdominal aortic aneurysms can be treated, or even cured, with highly effective and safe treatments.

Aneurysms can be caused by inflammation in the aorta, which may cause its wall to break down. Some researchers believe that this inflammation can be associated with atherosclerosis (hardening of the arteries). Besides atherosclerosis, other factors that can increase your risk of abdominal aortic aneurysm include:      

•  Being a man older than 60 years
•  Family History of AAA
•  Having high blood pressure
•  Smoking

Many people do not feel any symptoms with an abdominal aortic aneurysm. Occasionally, patients can experience:

• A pulsing feeling in the abdomen, similar to a heartbeat
• Severe, sudden pain in your abdomen or lower back. If this is the case, your aneurysm may be about to rupture.

If your aneurysm ruptures, you may suddenly feel intense weakness, dizziness, or back pain, and you may lose consciousness. This is a life-threatening situation and you should seek medical attention immediately.

Endovascular aortic repair (EVAR) has become widely used to treat AAA as compared to traditional open surgery. During the study, researchers found that EVAR was superior to open surgical repair and that this minimally invasive procedure has been increasing and improving over time. Findings also suggest that even as sicker patients have undergone EVAR, the short- and long-term outcomes have continued to improve with favorable outcomes.

Endovascular treatments have many benefits including: patients typically leave the hospital sooner and recover more quickly, have less pain and a lower risk of complications and lower mortality than traditional surgery because the incisions are smaller. Sometimes traditional surgery is required if the shape or the location of the aneurysm is not favorable for an endovascular treatment.

According to the lead author of the study Marc Schermerhorn, MD, AAA rupture is still a common cause of death. “Because there are typically no warning signs, heightened awareness among patients and physicians is needed. AAA can be diagnosed with a simple ultrasound and can now often be treated with an effective, durable, minimally invasive approach”, said Schermerhorn.