How is percutaneous embolization performed in the treatment of varicocele?

Updated: Jan 02, 2019
  • Author: Wesley M White, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Percutaneous embolization represents the least invasive means of varicocele repair. The internal spermatic vein is accessed primarily via cannulation of the femoral vein through a retrograde approach with subsequent balloon and/or coil occlusion of the varicocele. The advantages of percutaneous embolization include preservation of the testicular artery and the relatively noninvasive nature of the technique. However, the percutaneous approach can be fraught with troublesome access to the vein, and postoperative complications such as contrast allergies, arterial injury, thrombophlebitis, and coil migration are uncommon but tangible risks. This approach is often reserved for recurrent varicoceles after open surgical repair.

Shibata et al reported that intraoperative indocyanine green angiography (ICGA), which is regularly used in microsurgical neurosurgery, can facilitate microsurgical subinguinal varicocelectomy by enabling the visualization and identification of the testicular arteries in the spermatic cord. After the exposure of the spermatic cord blood vessels, ICG was injected intravenously under a surgical microscope and the resulting infrared fluorescence allowed surgeons to safely and quickly ligate the spermatic veins. [29]


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