Ateeque Ahmed Khan, Tanveer-ul haq, Anjum Ara Hasan.
Comparison of percutaneous embolization of varicocele by steel coils versus surgical ligation in terms of complications.
Pak J Surg Jan ;26(1):19-23.

Objective: Gonadal vein embolization is a relatively new technique introduced in the Department of Radiology of one of the tertiary care teaching Hospitals in Pakistan. Purpose of this study was to compare the technique with surgical ligation of varicocele in terms of complications. Design: Th is was a retrospective study. Sett ing: Department of Radiology, Aga Khan University Hospital, Karachi. Methodology: Total number of patients who presented for varicocele treatment were 108 and all patients had clinical varicocele. 93 patients out of 108 cases presented with infertility (86%) and 15 patients (14%) with physical complain of scrotal pain, swelling and or scrotal mass. 48 patients (44%), underwent Percutaneous embolization by coil primarily and 60 patients (56%) had surgical ligation of Gonadal vein. Duration of follow up in embolization group of patients was 1 – 4 years (mean 2.1 years). Follow up period ranged between 1-6 years with mean 3 years in surgical ligation group. Varicocele diagnosis was made on physical examination and in many cases confi rmed on ultrasound and Doppler examination. Result: In 48 patients who underwent Percutaneous embolization, 32 left sided unilateral varicocele were successfully embolized technically (72%) while 3 bilateral varicocele were also occluded successfully while technical failure seen in 13 cases. Total of patients who underwent surgical ligation were 78, out of which 14 cases showed recurrence. 60 patients primarily underwent surgical ligation, 6 patients showed recurrence. 18 cases of recurrence from embolization group secondarily underwent surgical ligation. 71cases out 78 were successfully occluded at fi rst att empt and 3 in second attempts, while 4 cases lost to follow up. So recurrence rate was 9(%) at fi rst att empt but over all recurrence rate was 5(%) in surgical group. Complications encountered during venous access, were extravasations in 3 cases and right internal carotid artery puncture in one case but no sequel were found and homeostasis secured. Conclusion: Our study emphasize that Gonadal vein embolization technique is superior to surgical ligation technique in term of lowest morbidity, and least discomfort, with negligible complications.

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