Technical and venographic variations in embolization of primary versus recurrent varicocele

Varicocele embolization is an established treatment for primary and recurrent varicoceles. However, technical outcomes and venographic patterns may differ depending on whether the varicocele represents a primary disease or a recurrence following prior surgery or embolization. This study compared technical performance and venographic characteristics across these clinical scenarios. We retrospectively reviewed 92 consecutive patients who underwent varicocele embolization at a single academic center between January 2021 and June 2023. Patients were stratified into 3 groups: primary varicocele (n = 43), recurrent varicocele after microsurgery (n = 42), and recurrent varicocele after prior embolization (n = 7). Technical success, venographic findings (including the presence of a patent refluxing internal spermatic vein and collateral channels), procedure time, radiation dose, and number of coils used were compared using the chi-square or Fisher exact tests for categorical variables and the Kruskal-Wallis test for continuous variables. Technical success was achieved in 100% of patients in both the primary varicocele and recurrent varicocele after microsurgery groups but was significantly lower in patients with recurrent varicocele after prior embolization (57%; P < .001). A patent refluxing internal spermatic vein was consistently present in the primary varicocele and recurrent varicocele after microsurgery groups but absent in the recurrent varicocele after prior embolization group (P < .001). Venous collaterals were identified in 86%, 67%, and 100% of cases in the primary varicocele, recurrent varicocele after microsurgery, and recurrent varicocele after prior embolization groups, respectively (P = .033). Procedure times differed significantly among groups (P = .017), with median times of 18 minutes (interquartile range [IQR] = 15-28) for primary varicocele, 23 minutes (IQR = 18-30.3) for recurrent varicocele after microsurgery, and 31 minutes (IQR = 26.5-41.5) for recurrent varicocele after prior embolization. Radiation dose also differed significantly (P = .03), with median doses of 131 mGy (IQR = 91.8-166.5), 120 mGy (IQR = 85.25-192), and 195 mGy (IQR = 151.5-207.5) in the respective groups. The number of coils used was comparable among groups (median 4 [IQR = 3-4]; P = .62). Recurrent varicocele demonstrates distinct venographic patterns depending on prior treatment modality. Recognizing these patterns may inform procedural planning and patient counseling in recurrent cases.