Pulmonary embolism after percutaneous embolization of left spermatic vein

Abstract

Embolization of the spermatic vein is regarded as a safe and reliable method for treating a varicocele [l-13]. A variety of techniques is used for percutaneous occlusion of veins making use of stainless steel coils, coils with polyester fibre strands (Gianturco), detachable balloons or sclerosing agents. Complications are reported in l-30% of cases [2,3]. These complications consist of perivenous contrast extravasation, testicular thrombophlebitis, flank pain, venous spasm, puncture of femoral artery, contrast reaction, stripping of intima, capture of catheter in thrombus and migration of obstructing device [ 1,3-61. In the literature four complications due to migration or inadequate positioning of obstructing devices are reported [2,6-91. In one case a detachable balloon was left in a spasmic vein, and dislodgement occurred when the venous spasm subsided [2,7,8]. Two authors mention protrusion of the tail of the coil into the renal vein [ 6,9]. In one case the coil could be manipulated into the left spermatic vein [ 61. In the other patient the coil had to be surgically removed [ 91. Another author reported on pulmonary embolism of a plastic sheath used to straighten the guide wire [ 3,10,11]. Clinical sequelae were detected in none of these cases. We report on a case of coil migration following percutaneous transfemoral obliteration of left spermatic vein using Gianturco coils.