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BackTable / VI / Topic / Procedure
Varicocele Embolization
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Varicocele Embolization Pre-Procedure Prep
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.
Varicocele Embolization Podcasts
Listen to leading physicians discuss varicocele embolization on the BackTable VI Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
Varicocele Embolization 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 Varicocele Embolization Procedure
Outcomes
• Technical success in 90-97%
• Recurrence rate 2-12%
Potential Varicocele Embolization Complications
• Left renal vein thrombosis
• Pampiniform plexus thrombophlebitis
• Treatment failure. Symptoms persist.
Varicocele Embolization Demos
Watch video walkthroughs of varicocele embolization on the BackTable VI expanded content network.
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. https://www.ajandrology.com/article.asp?issn=1008-682X;year=2016;volume=18;issue=2;spage=234;epage=238;aulast=Halpern
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