Varicocele Embolization

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Pre-Procedure

Indications:
Varicocele with pain, testicular atrophy, and/or infertility.

Contraindications:
Competent internal spermatic vein valve.
Non-symptomatic varicocele

Things to check:
Prior imaging- US/MRI
Sudden onset of any varicocele, or an isolated right varicocele should prompt imaging of the retroperitoneum to exclude an abdominal or renal mass.

Procedure

Right femoral or IJ access.
7 Fr. sheath from the groin, or 5 Fr if accessing from the neck.
Cannulate the left renal vein and internal spermatic vein.
Test the internal spermatic vein orifice for reflux under Valsalva with contrast injection.
Advance catheter or microcatheter (to avoid vasospasm) into the distal gonadal vein.
Can occlude the entire vein with coils, or a combination of coils, sotradecol, and/or Amplatzer plugs.
First coils placed at the level of the inguinal canal/superior pubic ramus.
Limit flow of sclerosant into the scrotum to avoid pampiniform plexus phlebitis via manual pressure or distal coil placement.

Post-Procedure

• Technical success in 90-97%
• Recurrence rate 2-12%

Potential complications:
• Left renal vein thrombosis
• Pampiniform plexus thrombophlebitis
• Treatment failure. Symptoms persist.

Related Procedures

No related procedures.

 

References

[1] Rogers, P., Roberts, A., & Wong, W. (2002). Pocket Radiologist: Interventional Top 100 Diagnoses (1st ed.). AMIRSYS.
[2] Halpern, J., Mittal, S., Pereira, K., Bhatia, S., & Ramasamy, R. (2016). Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications. Asian Journal of Andrology, 18(2), 234. http://doi.org/10.4103/1008-682X.169985

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Varicocele Coil Embolization

Animation by Boston Scientific on peripheral varicocele coil embolization.

 

Tools

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Literature

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Asian Journal of Andrology (Mar 2016)

Percutaneous Embolization of Varicocele Technique Indications Relative Contraindications and Complications

This review discusses the common indications, techniques, and risks associated with percutaneous embolization of varicocele.

Seminars in Interventional Radiology (Sep 2016)

Varicocele: A Review

Varicoceles are relatively common clinical problem that are associated with pain, testicular atrophy, and reduced fertility rates. This article reviews the anatomy, indications, treatment options, and potential complications related to varicoceles.

 

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