Varicocele embolization

Varicocele is a common condition in male patients whose impact can be clinical (pain, sensation of heaviness) and/or biological (abnormal sperm analysis, infertility). Our interventional radiology unit has been performing embolization procedures for ten years.

What does the treatment involve?

The American Hospital of Paris team is one of the few with expertise in the full range of embolic agents and embolization techniques, including the use of retrograde and anterograde access methods. This ensures an immediate success rate of close to 100 percent and one of the lowest recurrence rates.

Our interventional radiologists always give priority to liquid embolic agents, which require technical skill to administer but leave no residue in the veins that could complicate subsequent imaging tests. In fact, liquid embolic agents such as cyanoacrylates (“glue”) or aethoxysklerol disappear in less than six months while leaving the veins permanently obstructed.

What is varicocele embolization?

Varicocele embolization is a noninvasive, innovative procedure that uses an endovascular approach to treat the spermatic vein without surgery. The procedure is performed by an interventional radiologist on an outpatient basis and lasts approximately a half a day.

The interventional radiologist inserts a 1.6 mm-diameter catheter into a vein in the patient’s arm or groin. Under X-ray guidance, he or she then glides the catheter toward the spermatic vein supplying blood to the varicocele(s).

Once the catheter’s position has been verified, the spermatic vein is occluded using synthetic glue (a technique in use for over thirty years to treat cerebral vascular malformations) or sclerosing foam. To complete the procedure, the doctor may insert coils, which are tiny springs made of soft platinum that form a plug inside the vein.However, our team favors techniques without coils, the overuse of which is not recommended (publication in February 2022 in the journal Andrology).

When the embolization procedure is over, the radiologist removes the catheter. All that remains is a 2-millimeter incision that heals in less than 24 hours.

What are the benefits of varicocele embolization?

Varicocele embolization offers a noninvasive treatment for the debilitating pain and fertility issues caused by varicoceles.

Embolization is a technique used in interventional radiology offering multiple benefits. Performed on an outpatient basis and leaving no scar, it is highly efficient, minimally invasive and painless.

Moreover, unlike surgical techniques, embolization allows the doctor to see and therefore treat all of the dilated veins through a single procedure.

What to expect during a varicocele embolization procedure at the American Hospital of Paris

Prior to the procedure, you will meet with an interventional radiologist and an anesthesiologist for a consultation.

On the day of the procedure, after arriving at the Hospital’s outpatient department, you will be accompanied to the interventional radiology room, where the radiologist will meet you. The anesthesiologist and their team will prepare you for the procedure, for example by inserting an IV. The average length of the procedure is 30 minutes. You may choose to watch the procedure in real time, or have the anesthesiologist administer mild sedation to help you stay relaxed, but awake, throughout the procedure. 

Once the procedure is over, you will be monitored in the outpatient department for one hour before returning home. You can resume your regular activities – even exercise – the same day.

How should I prepare for varicocele embolization?

On the day of your consultation with the interventional radiologist, bring all of your varicocele-related imaging and lab results with you.

After taking your history and performing a physical examination, the doctor will be able to make an initial diagnosis. He or she may also perform a Doppler ultrasound if this hasn’t already been done.

What are the treatment outcomes of varicocele embolization?

Outcomes are remarkable when the procedure is performed thoroughly, meaning when all the collateral veins of the spermatic vein are treated, down to the very smallest. This prevents recurrence in the short term. The American Hospital of Paris team expertly performs embolization using liquid agents, which is the most effective at ensuring the necessary diffusion of the product and thus obstructing all of the collateral veins.    

In some patients, the catheter cannot be inserted into the spermatic vein via the classic route (anterograde approach through the lower vena cava or renal vein) due to severe spasms or a congenital deformation. At the American Hospital of Paris, this type of “technical” failure is avoided, since our team is also one of the few to master the spermatic vein retrograde direct puncture technique (having performed more than 50 such procedures with no complications).

What are the side effects of varicocele embolization?

The rate of major complications following varicocele embolization is practically zero.

Patients may experience light pain in the 48 hours that follow the procedure. You will benefit from individualized monitoring throughout this period to ensure any pain is efficiently and thoroughly managed.

When the procedure includes coil insertion, some patients report persistent pain and local inflammation. Our team gives priority to techniques without the insertion of coils. There may also be rare incidents linked to the injection of sclerosing foam, which cannot be seen on the images. Our team generally uses synthetic glue, whose diffusion in the veins is easily visible.


Le traitement des varicocèles par embolisation en images

Le traitement des varicocèles par embolisation en images

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