Figure. Left percutaneous retrograde embolization of persistent grade 3 varicocele after surgical ligation in a 15-year-old patient.

(a) Left retrograde gonadal venography through 5-F RDC catheter during Valsalva maneuver demonstrates the main gonadal vein (arrowheads) and a smaller, more lateral parallel channel (arrows) extending separately to the varicocele (which is intentionally excluded from the field of view to limit radiation exposure of the testicle). (b) The tip of an 5-F angled Glide catheter (arrowhead) has been advanced through the main gonadal vein and positioned caudal to the origin of the more lateral parallel channel seen in a. (c) With the angled Glide catheter positioned as in b, initial injection of boiling hot contrast medium is performed under live fluoroscopy to assure that no hot contrast medium extends below the inguinal ligament. (d) After embolization of the caudal portion of the main gonadal vein, the more lateral parallel channel (arrows) has been selectively catheterized, and boiling hot contrast medium is injected. (e) After embolization, there is a standing column of contrast medium in the main gonadal vein (arrowheads) and the more lateral parallel channel (arrows). Asterisk shows the tip of a Balkin sheath, which has been withdrawn into the inferior vena cava.

Longitudinal sonogram through the left testicle. This image shows several large anechoic tubes (2.4-6 mm in diameter) lying behind the upper and middle poles of the testicle. The diameter of these tubes increased by 1.5-2 mm with a Valsalva maneuver (not shown). T = testicle; v = varicocele.

Upper image: Longitudinal sonogram through the pampiniform plexus of the left testis. The image shows several anechoic tubes. Lower image: The application of color Doppler imaging in the same patient shows bidirectional flow within the anechoic tubes.

Left testicular venogram. This image shows a left testicular varicocele before embolization. Note: radiographs of varicoceles should be avoided to restrict radiation exposure.