VENOUS INSUFFICIENCY
VARICOCELE
Introduction
Last updated: apr 5, 2023
An important cause of infertility, this condition is not palpable in 24% of cases. It is usually left-sided (78%) and may present with symptoms due to retroperitoneal compression or thrombosis. Treatment is effective in over 50% of cases, making it a significant diagnosis.
The procedure in steps
- Time Out procedure (TOP)
- Drape according to protocol
- Access
- Infiltration with Lidocaine
- Unilateral venous puncture under ultrasound guidance
- Insert sheath
- Administer 5000 IU Heparin
- Use a Superglide Cobra catheter with a soft guidewire
- Selective catheterization of the left renal vein
- Optional direct catheterization of the left spermatic vein
- Always perform a series deep in the renal vein with Valsalva maneuver
- Only search for the right spermatic vein if indicated, same for iliac branches
- Primarily use pushable 0.035" coils; glue can also be used
- Place an additional cluster of coils proximally in the vein
- Control series
- Complete the procedure with manual compression
- Sign Out Procedure (SOP)
Complications
- Access (0.4%), hematoma, pseudoaneurysm, fistula
- Post-procedural testicular pain, which can last up to 10 days
- Spasm, perforation (avoid glue if perforation occurs due to risk of ureter involvement)
- Coil migration (rare with correct sizing)
- Pampiniform thrombosis and phlebitis, only with sclerotherapy (starts 24-48 hours post-procedure). Perform testicular ultrasound to rule out testicular necrosis. Treat phlebitis with corticosteroids and NSAIDs
- Recurrence rates in literature: 2-24%
Report
Time out akkoord. Patient in rugligging. Wassen met chloorhexidine en steriel afdekken. Echografisch geen stenose in de VFCD. Retrograde toegang, met 6F sheath. 5000 IE Heparine.
Echografisch geen stenose in de VFCD. Antegrade toegang, met 6F sheath. Selectieve katheterisatie van de vene renalis links. De vene spermatica is insufficient.
Manuele compressie
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