title: Endovascular transcatheter embolization of recurrent postsurgical varicocele: anatomic reasons for surgical failure.
abstract: BACKGROUND
  Formation or pre-existence of collateral gonadal veins in varicocele patients has been reported as the main cause of surgical treatment failure.
  
  
  OBJECTIVE
  To describe venographic findings in patients with postsurgical recurrent varicoceles and to assess the efficacy of the following minimally invasive endovascular treatment.
  
  
  METHODS
  Thirty-three men with failed surgical treatment of left-sided varicocele were examined between 2006 and 2013, using retrograde venography to assess the anatomy of varicocele draining veins before the attempted transcatheter embolization. Anatomic variants of gonadal veins were categorized according to the classification modified for the purpose of the present study. 3% polidocanol was used as an embolic agent together with pushable fibered coils.
  
  
  RESULTS
  In 31 (93%) out of 33 patients venography demonstrated incompetence of the gonadal vein or veins draining varicoceles after failed surgical treatment. The most frequent venographic finding was gonadal vein duplication - 66% of cases (39% in its mid-portion). Technical success of embolization was achieved in all 31 patients. No major complications were observed.
  
  
  CONCLUSIONS
  Retrograde varicocele embolization may be superior to surgery because of its ability to detect gonadal vein variants. In our study group, transcatheter embolization with 3% polidocanol and fibered coils allowed successful, minimally invasive treatment of postsurgical varicoceles.
authors.affiliation: Department of Interventional Radiology, Medical University of Lublin, Lublin, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Jargiello
authors.affiliation: Department of Interventional Radiology, Medical University of Lublin, Lublin, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Drelich-Zbroja
authors.affiliation: Department of Interventional Radiology, Medical University of Lublin, Lublin, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Falkowski
authors.affiliation: Department of Interventional Radiology, Medical University of Lublin, Lublin, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Sojka
authors.affiliation: Department of Interventional Radiology, Medical University of Lublin, Lublin, Poland k.pyra@poczta.fm.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Pyra
authors.affiliation: Department of Interventional Radiology, Medical University of Lublin, Lublin, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Szczerbo-Trojanowska
mesh_terms: D000293:Adolescent; D002406:Catheterization, Peripheral / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008297:Male; D010690:Phlebography / Q000379:methods*; D011183:Postoperative Complications; D015641:Radiography, Interventional / Q000379:methods; D012008:Recurrence; D013085:Spermatic Cord / Q000098:blood supply* / Q000000981:diagnostic imaging; D017211:Treatment Failure; D014646:Varicocele / Q000000981:diagnostic imaging* / Q000601:surgery*; D014680:Veins / Q000002:abnormalities*; D055815:Young Adult
keywords: Varicocele; postsurgical recurrence; trancatheter embolization; venography