22 year old with a 10 year history of left groin and testicular pain. Underwent embolization about 4 years prior with temporary improvement of symptoms. Only the proximal left testicular vein was embolized. The patient had asymptomatic compression of the left renal vein (Nutcracker Phenomena) leading to the develop of renal vein collaterals to the untreated portion of the the left testicular vein and a recurrent varicocele. Antegrade embolization of the left testicular vein was performed. The patients symptoms resolved and have not reoccurred. There is only one other reported varicocele being treated via this approach.
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.
Percutaneous bypass graft for severe critical limb ischemia
Current physiologic testing for ulcer perfusion may fail to identify patients with ischemia