Procedure Guide

Varicocele Embolization

An overview for this procedure is not yet available.

Step-by-step guidance on how to perform Varicocele Embolization. Review tools, techniques, pearls, and pitfalls on the BackTable Web App.

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.

Procedure Steps

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

Outcomes

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

Potential Complications

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

Varicocele Embolization Demos

Varicocele Coil Embolization

Animation by Boston Scientific on peripheral varicocele coil embolization.

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Demo Video

Varicocele Coil Embolization

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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

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.