Anatomic variants of the spermatic vein: Importance for percutaneous sclerotherapy of idiopathic varicocele

PURPOSE: To evaluate percutaneous sclerotherapy of idiopathic varicocele in left internal spermatic vein variants. MATERIALS AND METHODS: The left spermatic vein was embolized with a liquid sclerosing agent in 386 patients (mean age, 29.5 years) with idiopathic varicocele. Success and complication rates were assessed and correlated with spermatic vein variant. Doppler ultrasound was performed 3 and 6 months after therapy in 263 patients. RESULTS: The success rate was 93.8% (n = 362). Perforation of the vein was the most common complication (n = 24). The recurrence rate was 3.8% (10 of 263 patients). Success and complication rates were associated with spermatic vein variant. Type IVb (intact valve of the main trunk, insufficient collateral vessels; n 73) was of special importance: 67% (16 of 24) of all perforations occurred and 54% (13 of 24) of all unsuccessful interventional procedures were performed in patients with this variant. CONCLUSION: Sclerotherapy is a safe and effective alternative treatment of idiopathic varicocele. It can be performed on an outpatient basis. Success depends on the anatomic variant.