The aberrantly fed varicocele: frequency, venographic appearance, and results of transcatheter embolization

Retrograde flow in the internal spermatic vein, which is characteristic of varicocele, can occur despite competent valves because of the presence of bypassing anastomoses. The resulting condition has been called aberrantly fed varicocele. The purpose of this study was to determine the frequency of aberrantly fed varicocele, to analyze its various venographic appearances, and to review the results of attempted embolotherapy.

We performed left-sided (n = 213) and/or right-sided (n = 121) spermatic venography in 213 patients who were examined for infertility (n = 179), for physical complaints of their varicocele (n = 17), or for varicocele impeding testicular growth (n = 17). The resulting 334 venograms were subdivided as negative or positive for varicocele, and positive venograms were further classified as showing normally or aberrantly fed varicoceles. The aberrantly fed varicoceles were classified according to the sites of the bypassed competent valves and the levels at which the bypassing anastomoses joined the internal spermatic veins. The technical success rate of 192 attempted embolizations of normally and aberrantly fed varicoceles was determined.

Of the left-sided spermatic venograms, 42 (20%) were negative and 171 (80%) were positive for varicoceles, which in turn consisted of 125 normally and 30 (19%) aberrantly fed varicoceles (16 could not be classified). On the right side, 78 (64%) venograms were negative and 43 (36%) were positive for varicoceles, consisting of 34 normally and seven (17%) aberrantly fed varicoceles (two were not classified). Venographic classification showed that about half of the cases were in patients with competent orificial valves, which were bypassed by anastomoses joining the internal spermatic veins in their cranial lumbar subsegments. Competent valves lower down were seen only on the left side, and anastomoses joining the internal spermatic veins in their cranial pelvic subsegments occurred relatively more frequently on the right side. Coil embolization was attempted in 118 left-sided and 32 right-sided normally fed varicoceles and in 30 left-sided and seven right-sided aberrantly fed varicoceles. The technical success rate was 97% for left- and right-sided normally fed varicoceles and 73% for left-sided and 57% for right-sided aberrantly fed varicoceles.

Aberrantly fed varicoceles are found in 17-19% of patients examined with spermatic venography. Coil embolization of aberrantly fed varicoceles is usually successful, but not as reliably as with normally fed varicoceles.