Spermatic Vein Embolization

With the help of X-ray image-guidance, your doctor will insert a catheter into the vein and either place materials to block the vein or inject a substance called an embolic agent at the site of enlarged blood vessels. The embolic agent either blocks or causes the body to block the vessel, preventing the accumulation of blood in faulty vessels, and eliminating the varicocele.

When you arrive at the Interventional Radiology Department, a nurse will greet you and let the team know you’ve arrived. Before the procedure, you may have an ultrasound, CT, or MRI exam.

A nurse will bring you into the pre-procedure area and ask you to change into a gown. When you are brought in for your procedure you will be positioned on the examining table. The technologist or nurse will connect monitors for your heart rate, blood pressure, and pulse, and an intravenous (IV) line will be inserted into a vein in your hand or arm. This will be used to give you sedatives during the procedure. Some patients receive general anesthesia, but in most cases, this is not necessary.

The technologist will shave, sterilize, and cover the area of your body where a catheter will be inserted with a surgical drape, usually the inner thigh. Your doctor will numb the area with a local anesthetic. You may feel a small pinch as the anesthesia is given. Once the area is numb, your doctor will make a very small nick, and you may feel some pressure as the catheter is inserted, but you won’t feel any serious discomfort.

Once the catheter is in place, contrast material (dye) will be injected. You may feel a warm sensation as this happens. Then, using X-ray image-guidance, your doctor will locate the varicocele and insert the materials used to embolize (block) the vein.

Depending on the complexity of your condition, the procedure may take from 30 minutes to several hours. When the catheter is removed, pressure is applied to prevent bleeding, and the nick is bandaged. You will not require stitches.

You will be taken to a recovery area to rest. When you feel ready you will be able to go home.

Most patients feel some discomfort after the procedure. Medications can be given to control pain. You may also experience mild nausea or a low-grade fever.

There are things you can do to make your experience more comfortable, and many of these will depend on your individual preferences. You might like to keep a list of questions or — as you’re doing now — educate yourself about the procedure.

Some other things to keep in mind in planning for this procedure include:

• You should plan to have someone take you home after the procedure as you will not be able to drive after sedation.
• You will need to get blood tests to check your liver and kidney function.
• Your doctor may also request an EKG.
• Your doctor may ask you to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or blood thinners (such as Coumadin or warfarin) for a time before the procedure.
• Five days before the procedure, stop taking vitamin E.
• The day before the procedure (or the Friday before, if you’re scheduled for a Monday procedure), a nurse from the Interventional Radiology Department will call you. The nurse will give you any additional instructions, and will ask if you have any questions.
• In the 8 hours before the procedure, do not eat food.
• Up to 2 hours before you arrive at the hospital, you may drink clear liquids. Black coffee or tea are fine, but do not add cream or milk. You may sip water with medications.
• When you arrive, make sure the nurse and radiologist know about any allergies you may have, especially allergies to local anesthetics (such as lidocaine), general anesthetics (such as propofol), or X-ray dye (contrast media).

On the day of your procedure you should:

• Wear comfortable, loose-fitting clothes
• Wear comfortable shoes
• Avoid bringing jewelry or valuables

The benefits of a spermatic vein embolization could include:

• High chances of success. Success rates of 85% and higher have been reported with this procedure worldwide.
• The procedure is much less invasive than conventional surgical techniques. Your hospital stay is much shorter, and the recovery is faster. You lose less blood, and there’s no scar.

Some risks that you should be aware of include:

• The small chance that the procedure will not be successful in relieving your pain.
• Like any catheterization procedure, there is a risk of damage to blood vessels, bruising, bleeding, or infection at the puncture site.
• There is a small risk of infection at the site of embolization, even with antibiotics.
• The embolic agent could go someplace it is not supposed to go, and harm normal tissue.
• Keep in mind that this information is general. Your radiologist is the best source of information about how these risks and benefits may apply to you.