Percutaneous embolism is an advanced procedure performed by a radiologist. The specialist usually makes a small cut into a vein in the groin and inserts a tube. The doctor will use X-ray imaging to guide them to the affected veins and insert a coil or a balloon into it through the tube. The procedure helps in blocking the blood flow to the varicocele, shrinking it gradually. This procedure is also done with general anesthesia.
Catheter-directed embolization is a non-surgical, 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/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 without surgery.
Efficacy of Embolization for Varicoceles
Embolization is equally effective in improving male infertility and costs about the same as surgical ligation. Pregnancy rates and recurrence rates are comparable to those following surgical varicocelectomy. In one study, sixty percent conceived were treated for infertility.
In another study, sperm concentration improved in 83 percent of patients undergoing embolization compared to 63 percent of those surgically ligated. Patients who underwent both procedures expressed a strong preference for embolization.