For men diagnosed with a symptomatic or fertility-relevant varicocele, embolization offers a day-case, catheter-based alternative to surgical ligation. Because it involves working through the venous system rather than making an incision near the scrotum, many patients are curious about exactly what happens during the procedure itself. This walkthrough outlines the typical steps, while recognizing that individual technique and anatomy can vary the exact sequence.
Step One: Vein Access
Varicocele embolization begins with access to the venous system, most commonly through a vein in the groin (femoral vein) or, in some centers, a vein in the neck (internal jugular vein) or arm. A small needle puncture is used to introduce a sheath, through which catheters and other tools are passed. This step is performed under local anesthesia, and most patients remain awake throughout the procedure, sometimes with light sedation for comfort.
Step Two: Navigating to the Gonadal Vein
Once venous access is established, the interventional radiologist advances a catheter under fluoroscopic (X-ray) guidance through the venous system to reach the gonadal vein — the spermatic vein responsible for draining blood from the testicle, which becomes abnormally dilated and refluxing in a varicocele. Contrast dye is injected to confirm the anatomy and to visualize the extent of venous reflux before proceeding further.
Step Three: Confirming the Target With Venography
Before any embolic material is deployed, a venogram (an X-ray image using contrast) is obtained to map the full course of the gonadal vein and identify any collateral or accessory veins that may also need to be addressed. This step matters because incomplete treatment of collateral pathways is a recognized contributor to recurrence in some patients, and thorough imaging helps guide a more complete treatment.
Step Four: Deploying the Embolic Material
Once the target vein and any relevant collaterals are mapped, embolic material — most commonly coils, sometimes combined with a sclerosing agent or vascular plug depending on operator preference and anatomy — is deployed at specific points along the vein to achieve occlusion. The goal is to block reflux of blood down the vein while preserving normal venous drainage elsewhere. A final venogram is typically obtained to confirm that flow through the treated vein has been successfully occluded.
Step Five: Closing the Access Site and Recovery
Once occlusion is confirmed, the catheter and sheath are removed, and the small access site is closed with manual pressure or a closure device. Most patients are monitored for a short period afterward and are then able to go home the same day, making this a genuine day-case procedure for the majority of appropriately selected patients.
What About Recurrence?
Some patients experience recurrence of the varicocele after embolization, which can be related to incompletely treated collateral veins, anatomical variation, or the natural biology of venous reflux over time. Recurrence rates reported in the literature vary by study and technique, and any recurrence should be evaluated by a qualified physician to determine whether repeat embolization, surgical treatment, or observation is most appropriate.
The Devices Behind Varicocele Occlusion
Reliable, stable occlusion of the gonadal vein depends on embolic devices designed for controlled deployment and minimal migration risk. INVAMED manufactures the MultiBEAM Embolization Plug, a self-expanding, multilobe nitinol occlusion device with manufacturer-reported indications including varicocele treatment; further information is available on the MultiBEAM Embolization Plug product page. Availability and indications vary by country, and the Instructions for Use (IFU) should always be consulted.
Device availability and regulatory status vary by country. Please contact INVAMED or your authorized local distributor for current regulatory information applicable to your region.