Persistent and recurrent postsurgical varicoceles: venographic anatomy and treatment with N-butyl cyanoacrylate embolization.
OBJECTIVE
To elucidate the mechanism of persistence or recurrence of varicoceles after surgical repair by examining the venographic anatomy, and to review the efficacy of treatment of these patients with n-butyl cyanoacrylate (NBCA) embolization.


METHODS
From 2001 to 2007, 17 patients with persistent or recurrent varicoceles were studied by retrograde venography 4 months to 18 years after open surgical repair. All patients were then treated with NBCA glue embolization of the entire gonadal vein and the venographically identified duplications and collateral vessels, with three patients undergoing bilateral procedures. Venographic anatomy and clinical success were retrospectively analyzed.


RESULTS
The majority of patients (65%) exhibited duplications draining into a single left gonadal vein. Duplications were most frequently found to be confined to the pelvis and inguinal canal. Communication with other retroperitoneal veins, including the renal hilar, lumbar, iliac, and circumaortic renal vein, was relatively uncommon. NBCA embolization effectively treated the main gonadal vein as well as the duplications and communications, with only one patient developing thrombophlebitic complications.


CONCLUSIONS
Duplication of the gonadal vein in the pelvic or inguinal region with apparent incomplete ligation or resection is a common finding in patients with persistence or recurrence of varicocele after surgery. NBCA embolization effectively treats these duplicated vessels, resulting in a high rate of clinical success on short-term follow-up.
Sze
Daniel Y
DY
Division of Interventional Radiology, Stanford University Medical Center, H-3646, 300 Pasteur Drive, Stanford, CA 94305, USA. dansze@stanford.edu <dansze@stanford.edu>
Kao
Jeffrey S
JS
Frisoli
Joan K
JK
McCallum
Stuart W
SW
Kennedy
William A
WA
Razavi
Mahmood K
MK
D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010690:Phlebography; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D013085:Spermatic Cord / Q000098:blood supply*; D016896:Treatment Outcome; D014646:Varicocele / Q000000981:diagnostic imaging / Q000628:therapy*; D014680:Veins / Q000002:abnormalities
D004659:Enbucrilate