High ligation or embolization of varicocele

The presence of a varicocele was confirmed in 121 of 123 patients complaining of scrotal pain or infertility, in whom radionuclide scanning was performed. In the first 29 patients (retrospective study), a high ligation of the internal spermatic vein was performed. In 94 patients, a percutaneous venography was done via the jugular vein followed by embolization by Gianturco coils (occluding spring embolus, Cook Group Company, USA) in 84 of them. In eight patients, due to technical difficulties during the embolization trial, a high ligation was performed at a later date. Eleven patients underwent embolization after failed high ligation. A posttreatment follow-up radionuclide study revealed recurrences in two of the 95 patients who underwent embolization. Embolization can be performed on an outpatient basis with minimal risks. Reembolization is feasible, and it in no way prevents a further high ligation should this be necessary.