Avatar universal

Persistent Left Varicocele

Dear Doctor,

I hope you are doing well.  My history is the following.

- Microscopic Varicocelectomy April 2013.  Failed with varicocele becoming much worse than before surgery. (Only 1 vein ligated).

- Varicocele Embolization June 2013. Improved the situation greatly but was not 100% successful.  The strange thing was that I did not have a varicocele while standing after the procedure, but only experienced the discomfort and "pooling" of blood while sitting.  This became worse, the feeling of blood "pooling" in my veins every time I sat down for more than 10 minutes became extremely stressful.  There was a distinct warm feeling that came with this feeling.

- Due to the constant "pooling" of blood and the stress it was causing me, I decided to have a third embolization in on April 29, 2014.  The doctor stated that a new channel formed above the previously embolized area, so he came up hire and embolized the gonadal vein up until about ~1" from the Renal Vein.

After my 3rd procedure, I am still experiencing the exact same feeling as before.  This includes no or minimal varicocele when standing, but "pooling" of blood, enlarged veins in the left sack, and heat when sitting down for more than 5-10 minutes or when laying down on the left side of my body in this same area.

I understand that I just had the procedure (4 days ago), so I should give it more time to deem it a success or not.  However, I would like to know with the sensation described above, could it still be possible in your opinion for this embolization to be a success?  Or are the feelings I am getting above indicative of a recurrent varicocele?

For example, if the portion above the channel was fully embolized, what could be "filling" the veins in my sack while I am sitting?  Is it normal for the coils to take time to "cauterize" to the embolized vein before it will fully block the back flow?  

Thank you and I appreciate your comments.
6 Responses
563773 tn?1374246539

Thanks for posting your query.

I can understand your concern for the second varicocele embolization after microscopic varicocelectomy also.

Unlike varicocele surgery, embolization requires no incision, stitches, or general anesthesia but still complete removal is not possible. Embolization can be used if surgical approaches are contra-indicated as success rates with surgery are higher.

The size of the varicocele (enlargement of the veins) after embolization will decrease in several weeks. Most prominent veins should disappear immediately , rest takes weeks and disappear progressively. Hence if you are noticing pooling of blood even after varicocele embolization then it may take weeks to disappear or may not disappear altogether. n approximately 5 to 10 percent of patients who undergo varicocele embolization, the varicoceles return. In that case, surgery may be needed.

Hence if the symptoms persist after 4-6 weeks of embolization then get it evaluated for any recurrence of varicocele. This is because the veins left behind to do the job of taking the blood from the testes may themselves enlarge or dilate with the extra blood they will now have to carry. Hence in that case, surgery would be a better option.

During embolization we inject embolic materials through the catheter, blocking the varicocele-causing vein and diverting blood to healthy veins. Hence the feeling of blood flow returning may be in the healthy veins which are overloaded.
Hope that this information helps and hope that you get better soon.

Wishing you good health.

Avatar universal
Hello Doctor,

The Gonadal vein near the Renal vein was embolized.  Theoretically, this would have embolized all of the veins going to the testes.

Is it possible for a vein that is embolized to try to continue bringing blood back to the heart up until the embolization coils?  Can this cause the vein to remain enlarged even after embolization?  Please explain why or why not this would be possible.
Avatar universal
Avatar universal
Hi Doctor,

Can you comment on my follow up?
563773 tn?1374246539
Thanks for writing back to me.

Gonadal vein is usually embolised for varicocele. However studies have shown low rate of technical success in obliteration of varicocele by steel coils with high rate of failure and recurrence when it is done via gonadal veins as well. Considering this, embolization failure and recurrence can also occur and hence enlargement of vein can occur. If embolization was successful then there should be no enlargement or pooling of blood.

I sincerely hope that helps. Take care and regards.

Avatar universal

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