What is Varicocele?
A varicocele is an enlargement of the veins in the scrotum, typically on the left side. A varicocele is similar to a varicose vein you might see in your leg.
Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. Varicoceles can also cause testicles to fail to develop normally or shrink. This develops when valves in the testicular vein become incompetent and the vein enlarges due to increased pressure. Around 15% of men in the general population have a varicocele and that rate increases dramatically to 40% in those men who suffer from primary infertility.
Common signs that you might have a varicocele include:
- Impaired fertility
- Sharp or dull discomfort or pain in the left testicle
- Pain or discomfort that increases with standing or physical exertion
- Pain or discomfort that gets worse throughout the day
- Pain or discomfort that is relieved when you lie on your back
How is Varicocele treated?
The most commonly performed treatment for this condition is surgery performed by a urologist, but that is a more invasive, higher risk option. At ECCO we treat Varicocele with a Gonadal Vein Embolization, a less invasive, lower risk procedure where patients enjoy a much shorter recovery period.
After imaging diagnosis and clinic consultation, we will perform a venogram with the intention of placing a coil to embolize the left gonadal vein. This procedure has a 90% success rate, and the remaining 10% have some form of relief, with some of them requiring additional intervention.
Note: There is no significant difference in success rates between invasive surgery or minimally-invasive intervention
What is Venogram with Intervention?
“Veno” means vein and “Gram” means picture. So, using ultrasound guidance our physicians inject dye into your veins and use X-ray technology to “see” the veins and assess their functionality to determine the correct treatment plan. Once the proper path is determined, a vein in either your arm, leg or neck is then perforated with a hallow needle, using ultrasound guidance. A wire is then advanced, under X-ray guidance, into the vein.
Next, depending on your need, possible interventions include:
- Angioplasty: Specialized balloons can be advanced over the wire and inflated to open blockages or narrowed veins.
- Stent placement: Stents (tubular metal scaffolds) can be placed in the vein to keep it open if the vein cannot stay open on its own.
- Embolization: If indicated, we can use coils or plugs to shut down a non functional vein.
- Thrombolysis: If there is a large amount of clot (known as Deep Vein Thrombosis, or DVT) in the arm, leg, abdomen, etc., a specialized catheter can be temporarily placed within the clot itself which emits a medication that dissolves the clot on contact. This may be done over a 24-hour period involving an ICU stay.
In some cases, Intravascular ultrasound (IVUS) may also be used to evaluate the veins internally.
These interventions are performed as outpatient procedures at ECCO or a local hospital. Depending on the condition being treated, the procedure may require general anesthesia, and in many cases can be done with moderate sedation. Since there are no incisions, recovery time is brief. The main limitation is no heavy lifting (defined as > 15 lbs) for five days following the procedure. Occasionally, temporary blood thinners may be needed following the treatment.
What conditions are treated with a Venogram?
The list is long, but some of the more common conditions treated are:
- DVT (acute and chronic)
- May-Thurner Syndrome
- Pelvic Congestion Syndrome
- SVC Syndrome