Gonadal Vein Embolization: Treatment of Varicocele and Pelvic Congestion Syndrome

Abstract

Therapeutic embolization of the gonadal veins is performed on male and female patients for different clinical situations using similar techniques. The testicular varicocele is a common clinical problem associated with pain and reduced fertility rates. In women, chronic pelvic pain can be attributed to pelvic congestion syndrome, which is said to result from retrograde flow in incompetent ovarian veins. Both of these clinical problems respond well to gonadal vein embolization. In this article, we review the clinical evaluation, diagnostic workup, and technical aspects of percutaneous intervention of gonadal vein embolization. The supporting literature is also reviewed.

Antegrade pampiniform plexus venography in recurrent varicocele: Case report and anatomy review

“…Both surgical and percutaneous routes have provided effective treatment with reported recurrence rates up to 20% [1][2][3] . The reason for recurrence, most frequently demonstrated by retrograde gonadal venography, is collateralization of the gonadal vein by retroperitoneal collateral flow.…”

“…Spermatic venography is the "gold standard" for diagnosis but is primarily employed during intended treatment of varicocele, be it surgical or percutaneous [6,[9][10][11][12] . Reflux that lasts at least two seconds has been reported as equivalent to a positive venography result [1] . The goal of treatment of varicocele is interruption of retrograde flow into the pampiniform plexus from the gonadal and pre-existing collateral veins.…”

“…Secondary varicoceles may form as a manifestation of various disease processes, such as cirrhosis, abdominal neoplasms, portal hypertension, or heart failure [4] . Varicoceles can present with scrotal discomfort, or alternatively low semen counts and abnormal sperm motility as a treatable cause of male infertility [1,2,5,6] . The pampiniform plexus is a network of veins arising from the testicular venous outflow.…”

“…The reason for recurrence, most frequently demonstrated by retrograde gonadal venography, is collateralization of the gonadal vein by retroperitoneal collateral flow. Controversy exists as to the indications for treatment of varicocele, as well as the methods, which include a variety of surgical techniques, involving ligation of the gonadal vein, or percutaneous embolization with coil occlusion with or without venous sclerosis [1,5,7,8] . Initial evaluation of a varicocele usually begins with a physical examination, where scrotal palpation is performed with the patient relaxed and during a Valsalva maneuver [1] .…”

“…The pampiniform plexus is a network of veins arising from the testicular venous outflow. It begins in the scrotum and extends into the spermatic cord, then coalesces to form the gonadal vein, which travels through the inguinal canal and into the retroperitoneum [1] . On the left, the gonadal vein usually drains into the left renal vein.…”