1 % or 3 % sodium tetradecyl sulfate creates an endothelial surface damage-induced inflammatory reaction. STS has a low risk of extravasation, systemic dispersion, and adverse reactions.

STS foam is a mixture of 2 mL STS, 1 mL Lipiodol, and 3 mL of air. It improves the distribution of the sclerosing agent and its contact with the endothelial wall. Gandini uses two 10 mL Luer-Lock syringes containing 1 mL of 3 % STS and 4 mL air connected through a three-way stopcock that is vigorously mixed to form the foam prior to injection.

Some authors have reported good results with coils alone. However, early recurrence will take place with the endogenous lysis of the thrombus. We suggest the use of coils in association with a sclerosing agent. Also, late recurrence is frequently related to coil erosion. In Shlansky-Goldberg et al.’s study, the technical failure was 12 % and recurrence 4 % with coils in 173 varicoceles [22].

Glue (n-butyl cyanoacrylate) is a tissue adhesive agent. This agent is permanent; however, recanalization can be observed. Sze et al. reported no recurrence in 17 patients who had undergone embolization for postsurgical recurrence [18].

Absolute ethanol is a permanent agent that induces thrombosis by denaturing blood proteins, dehydrating vascular endothelial cells, and precipitating their protoplasm; the agent denudes the vascular wall.

surgery is performed by high retroperitoneal or transinguinal ligation of the ISV. The problem is the high frequency of venous collaterals, with either recurrence or persistence of the varicocele. Surgical recurrence rate or persistence of venous reflux in the pampiniform plexus ranges between 0 and 28 % [22]. Following a laparoscopic approach, the recurrence rate reported is 7–9 % [20], and for microsurgical technique, the recurrence rate is 0–3 % of cases [23, 24].

Patients are treated on an outpatient basis under sedation or general anesthesia. See Chap. 3 for sedation information. Intraprocedural monitoring includes heart rate, blood pressure, and pulse oximetry.

When performing varicocele embolization, careful collimation, pulsed fluoroscopic acquisition, and appropriate gonadal shielding are important to minimize the patient dose. Videocapture is used rather than exposures.

Traditional technique involves the use of a sclerosing agent in the lower ISV and placement of coils in the proximal portion. Sandwich technique was described by Goffette et al. (Fig. 10.7) [25]. Distal occlusion is performed with a nest of coils just above the pubic ramus. Thereafter, sclerosing agent is injected to reach all potential collaterals. Finally, coil occlusion is performed proximally. This approach avoids the reflux of the sclerosing agent to the scrotum and prevents phlebitis of the pampiniform plexus. Success rate of this technique is 91 % and lack of recurrence is reported in 73 % of cases. Mazzoni et al. [21] reported no recurrence in 79.4 % and Feneley et al. in 81 % [26].