Currently there are two treatment options for men with varicoceles: catheter-directed embolization or surgical ligation
Catheter-directed Embolization
Catheter directed embolization is a nonsurgical, outpatient treatment performed by an interventional radiologist using imaging to guide catheters or other instruments inside the body. Through mild IV sedation and local anesthesia, patients are relaxed and pain-free during the approximately two-hour procedure.
For the procedure, an interventional radiologist makes a tiny nick in the skin at the groin using local anesthesia, through which a thin catheter (much like a piece of spaghetti) is passed into the femoral vein, directly to the testicular vein. The physician then injects contrast dye to provide direct visualization of the veins so he or she can map out exactly where the problem is and where to embolize, or block, the vein. By using coils, balloons or particles, the interventional radiologist blocks the blood flow in the vein, which reduces pressure on the varicocele. By embolizing the vein, blood flow is re-directed to other healthy pathways. Essentially, the incompetent vein is "shut off" internally by preventing blood flow, accomplishing what the urologist does, but without surgery.
Surgical Ligation
Usually, outpatient surgery is performed under general anesthesia. During this treatment, the surgeon makes an incision above the scrotum and cuts through the layers of tissue to expose the faulty veins. The affected veins are tied off, ligated, to redirect the blood flow into normal veins. A laparoscope is sometimes used to perform the procedure. Recovery usually takes up to six weeks before heavy lifting and other strenuous activities can be performed.
Efficacy
Clinical resolution of pain and swelling and restoration of blood flow in the vein is greater than 85 percent with the catheter-directed technique.
Reprinted with permission of the Society of Interventional Radiology © 2004, www.SIRweb.org. All rights reserved.