13th Annual Global Embolization Symposium & Technologies
Purpose : Varicoceles are abnormal dilatations of the pampiniform venous plexus that lead to pain, testicular atrophy and reduced fertility rates. The incidence of varicoceles is 15% in adolescent males and up to 40% in infertile men1. 85% of cases are left-sided with right-sided incidence being less than 1% and bilateral varicoceles representing 14%. The standard of care continues to be surgical varicocelectomy however alternative treatments include sclerosis and coil embolization of gonadal veins. The aim of this study is to evaluate outcomes of patients treated with distal sclerosis (beyond the inguinal ligament) and coil embolization.
Material and Methods : Retrospective chart review from January 1, 2015 and July 30, 2018 identified a total of 11 patients aged 17 to 54 (mean 34, median 27) who underwent infra-inguinal venous sclerosis and gonadal vein coil embolization. Isolated left varicocele was present in 8 patients (73%) and bilateral varicoceles in 3 patients (27%). No patients had isolated right varicocele. 4 patients had previously undergone varicocelectomy (36.4%). 11 patients (100%) presented with pain and 4 (36.4%) had concurrent infertility. 11 (100%) patients underwent venous sclerotherapy with a mixture of 3% sotradecol, gelfoam, and lipiodol. 10 (91%) patients underwent concomitant gonadal vein coil embolization. Clinical and imaging findings, technical factors and success, clinical success, complications, resolution of presenting symptoms, and fertility outcomes were recorded.
Results : Each patient underwent a single procedure (11 total procedure). Venous access was established at the right common femoral vein in 1 patient (9%), right greater saphenous vein in 2 patients (18%) and right internal jugular vein in 8 patients (73%). 4 patients underwent bilateral infra-inguinal sclerotherapy and gonadal vein coil embolization, 6 patients underwent unilateral infra-inguinal sclerotherapy and gonadal vein coil embolization and a single patient underwent infra-inguinal sclerotherapy alone. Volume of sclerosant mixture ranged from 1 - 15 mL (mean 5.4, median 4). 10 patients (91%) had complete interval resolution of symptoms with 1 (9%) developing recurrent left varicocele at 3-year follow-up. Additionally, 3 of 4 patients (75%) had resolved infertility issues with 3 successful pregnancies and the fourth patient without repeat semen analysis secondary to age. No major complications and two minor complications were recorded. One case of superficial thrombophlebitis did not require treatment while one case of orchitis resolved after antibiotic therapy.
Conclusions : The endovascular treatment of varicoceles with coil embolization and/or sclerosis is a safe and appropriate therapy for patients with varicoceles causing pain and/or infertility including patients with failed operative therapies.