Article
Varicocele Embolization Procedure
Dr. Chris Beck • Updated Jan 2, 2024
Varicocele embolization is a minimally invasive procedure used to treat varicoceles, which are enlarged veins in the scrotum that can cause pain, swelling, or infertility. During the procedure, an interventional radiologist inserts a catheter through a small incision, typically in the groin or neck, and guides it to the affected veins. Embolic agents are then released to block the enlarged veins, redirecting blood flow to healthier veins and reducing swelling. This technique is highly effective for managing varicoceles, offering a quicker recovery time and fewer complications compared to traditional surgery. Varicocele embolization is commonly recommended for men who experience symptoms or have infertility concerns, providing long-term relief while preserving normal function.
Table of Contents
Pre Varicocele Embolization Procedure Prep
Varicocele Embolization Procedure
Post Varicocele Embolization Procedure
Pre Varicocele Embolization 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.
Featured Podcast
Episode # 497 • 22 Nov 2024
Essential Guide to Varicocele Embolization
Varicoceles embolization is the least invasive treatment option for varicoceles, making it the favored option for most patients and a staple in the interventional radiologist’s procedural repertoire. Dr. John Matson joins host Dr. Ally Baheti to give us an essential guide to varicocele embolization, serving as an introduction for junior IRs and refresher for the more experienced. Dr. Matson is an Assistant Professor of Interventional Radiology at University of Virginia.
This podcast is supported by
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.
Additional resources
[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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