Sometimes. In the 15-year series, about 6 in 100 varicoceles were confirmed back on ultrasound, at an average of just under three years. Here’s the more interesting number: among men whose varicocele was found again on ultrasound, only about 1 in 6 had their pain come back. The picture and the symptom come apart. If it does come back and it bothers you, it can usually be treated again. Against surgery, the pooled comparisons split: one analysis of 16 studies found no difference in recurrence, a larger one of 30 studies found it modestly more common after the catheter route.

Varicocele embolization · the pinhole treatment — no incision, no general anesthetic

The ache comes from a leaking vein. Here’s how we close it — without an incision.

Q: What if the vein can’t be reached?

It happens — in about 4% of cases in one large series and about 12% in another. The vein is attempted, it can’t be catheterized safely, and the procedure is stopped without anything being closed. You should know before you consent that this is possible. If it happens to you, nothing has been lost: surgery remains fully open to you, and we’ll help arrange it.

A varicocele is a cluster of swollen veins above the testicle — varicose veins, in a worse place. When it aches, varicocele embolization closes the leaking testicular vein from the inside: through a pinhole, with no incision, no general anesthetic, and nothing done to the testicle itself. It’s performed in our own office under IV sedation, and you go home the same day. In the one study that measured it, men were back at work in about a day and a half.³ Covered by most insurance plans, and we’re in-network with most plans. No referral needed for your initial consultation.

Call (210) 405-1335 Book online

Covered by most insurance plans No referral needed for your initial consultation

Image to come · before & after venogram A de-identified pair from an ARVC case: the dye map before — the failed testicular vein and its branches filling backward toward the scrotum — and after, with the coils in place and no flow below them.Spec: de-identified, no patient identifiers in the frame. Kevin is holding imaging for this line and will send it. If no venogram pair exists, swap in a procedure-suite or catheter-table photo instead.

How people find this page

Maybe you’ve had the standing exam and the answer was “yes, it’s a varicocele, and yes, it explains the ache.” Maybe a urologist offered surgery and you went looking for the alternative. Maybe you had surgery years ago and it came back. Or maybe you just read the word embolization for the first time this week and want to know what it actually involves.

If you’re still at the “is this a varicocele — and is it my varicocele that’s causing this?” stage, start with our varicocele page — it covers what’s happening, why it aches, why it gets missed, how we examine you (standing), and every option including the ones we don’t perform.

This page is for the next question: what the procedure actually does, what it doesn’t, what the numbers really are, and what the day is actually like.

The procedure

The whole idea in four sentences.

Blood is pooling because the valves in one vein have failed. Close that vein, and the blood takes a different route — through the healthy veins running alongside, which your body already has. Pressure drops, the pooling stops, and the swollen veins below shrink back down over the following weeks. And because the closing is done from inside the vein, nothing is cut, nothing is removed, and nothing is done to the testicle itself — the whole procedure happens inside a vein high in your abdomen, well above the scrotum.

Here’s how. Through a pinhole in a vein — at the groin or the neck, depending on your anatomy — an interventional radiologist guides a catheter — a tube about the width of a spaghetti strand — up into the testicular vein, watching on a live screen. Dye is injected, and the failed vein and every branch feeding it light up. That map matters: a varicocele is often fed by more than one branch, and the branches that get missed are the ones that bring it back. Then the vein is closed with a combination of small, soft metal coils and a sclerosing agent — a medication that makes the vein wall seal shut. The coils close the main channel; the sclerosant reaches the smaller branches a coil can’t. If both sides need treating, both are done in the same session, through the same pinhole.

Why you probably hadn’t heard of it. Embolization isn’t new and it isn’t experimental — doctors have been closing testicular veins this way since the late 1970s, and there are published series following patients for 15 years.¹ The reason it may never have come up is that it isn’t performed by urologists. It’s performed by interventional radiologists: a different specialty, with different training and a different referral network. That’s not dishonesty. It’s how medicine is organized, and it happens in every condition two specialties can treat. What we won’t do is tell you your urologist was wrong. For a man trying to conceive, the American guidelines name surgery, and your urologist would be following them.⁴ For a man whose problem is the ache, there’s a genuine choice to make — and you should get to make it. — the same reason women hear “hysterectomy” long before they hear “embolization”

A doctor pointing to the veins on an anatomical model of the male reproductive system while a patient looks on — **Walked through before anything is scheduled** At your consultation the route is shown on a model — where the failed vein runs, and where the coils go. You’ll understand the plan before you agree to it.

Before any of this is scheduled, you’ve been examined standing. A varicocele fills when you stand and drains when you lie down; the standing exam and standing ultrasound are how we confirm the varicocele we can feel is the one causing your ache — and that it can be felt at all. Finding one is not the same as treating one. The full workup is on the varicocele page.

The transparent part

Three things to know before any results.

About the coils — the question men actually ask

If you’ve been reading forums, you’ve seen men worry about the coils. Straight answer: they are small, soft, and permanent, and they sit inside a vein high in your abdomen — not in your scrotum, not against the testicle. Some men online say they feel them. Most feel nothing at all — but we won’t tell you nobody ever has. The largest long-term study compared coils alone, coils plus a sclerosing agent, and a plug device, and found no statistically significant difference in outcomes between them,¹ so this is a genuine conversation to have with your doctor, not something anyone needs to defend. We use the coil-and-sclerosant combination, and we’re happy to explain why at your consultation.

It can be attempted and not completed

Sometimes the vein simply cannot be catheterized safely — about 4% of cases in one large series,¹ about 12% in another² — and the procedure is stopped without anything being closed. You should know before you consent that this is possible. If it happens, nothing has been lost: surgery remains fully open to you, and we’ll help arrange it.

Roughly 3 in 10 men don’t get the relief they came for

In the pain series with the longest follow-up — a median of 44.5 months — 7 in 10 men had their pain resolve or ease enough to be satisfied.² We’re leaving that number exactly where it is. And about 6 in 100 varicoceles come back on ultrasound, at an average of just under three years¹ — marginally more than after microsurgical repair. If it comes back and it bothers you, it can usually be treated again. We won’t call it a cure.

Limits first, results second — that’s the order you deserve. One more honest section, for the men who came here about fertility. Then the day itself, then the studies.

If you’re here about fertility

Read this part first. We’d rather you heard it from us.

A couple sitting on the floor of their living room, talking seriously

Treating a varicocele can improve semen quality. It does not guarantee a pregnancy, and no honest page will tell you otherwise. What follows is where this procedure stands for men trying to conceive; the wider fertility picture — and every option including the reproductive route — is on the varicocele page.

Here’s what the guidelines actually say. For men trying to conceive who have a varicocele that can be felt, infertility, and abnormal semen results, the American Urological Association and the American Society for Reproductive Medicine advise considering surgical varicocelectomy — not embolization.⁴ Microsurgical repair has the lowest recurrence rate of any treatment and the deepest fertility evidence base. We don’t perform it. We refer for it, routinely, and if you’re trying to conceive it may well be your better choice.

Where embolization stands. In the one prospective head-to-head study, 76 infertile men had either microsurgery or embolization. Pregnancy rates and semen improvement were equivalent; the embolization group had less post-procedure pain, no complications, and took 1.5 days off work against 6.8.³ The authors’ word was equivalent, with a slight advantage on recovery — and that’s the word we use. Not “better.” It was a small study, and it wasn’t randomized; it’s context for a conversation, not a claim.

What the pooled evidence adds. A 2022 meta-analysis in the Journal of Vascular and Interventional Radiology pooled 16 studies comparing the two routes — 2,138 men, seven of those studies reporting pregnancies — and found pregnancy rates after embolization statistically indistinguishable from surgery (RR 1.02).⁵ Two caveats we’d rather state than have you find: the 76-man study above sits inside that analysis, so it isn’t independent confirmation, and the surgery being compared is a mix of open, laparoscopic and microsurgical repair rather than microsurgery alone. It does not move embolization ahead of surgery for fertility, and it did not look at semen results at all. What it does is put more than one small study behind the word equivalent.

So if conception is the goal: start with a urologist or a reproductive urologist, and get a semen analysis. Come talk to us if surgery isn’t possible or isn’t wanted, if you’ve had surgery and it came back, if you have one on each side, or if you’d like a second opinion on what’s actually there — examined standing. If surgery is genuinely your better option, we’ll say so. Semen testing after any treatment is usually repeated at about three months, because that’s how long sperm take to develop.

Procedure day

In our office. About an hour. Home the same day.

Before anything is scheduled: you’ve had a consultation. You’ve been examined standing and scanned standing. Your history and any prior workup have been reviewed, the ache has been matched to the varicocele we can feel, and your benefits have been checked. You know where you stand — medically and financially — before you commit to anything.

The morning of: you come to our office — not a hospital. The procedure happens in our own interventional radiology suite. You’ll have fasted beforehand, and you’ll bring a driver — no exceptions: that’s the sedation, not the procedure. You’ll get the exact instructions, in writing, well before the day.

During the procedure: an IV delivers sedation — you’re relaxed and drowsy, breathing on your own, with a dedicated sedation nurse with you the whole time. Not general anesthesia. The interventional radiologist numbs a spot at your groin or your neck — whichever suits your anatomy; you’ll know which beforehand — and enters the vein through a pinhole — no incision, no stitches; a bandage covers it afterward. The catheter travels up to the testicular vein. Dye flows, and every failed branch shows itself. The vein is closed with coils and the sclerosing agent; if both sides need treating, both are done now, through the same pinhole. You won’t feel any of this happening — most men describe pressure rather than pain. The procedure itself is roughly an hour; plan on about three hours at the office.

Afterward: the catheter comes out, the pinhole is sealed, and you recover with us for about an hour. Then your driver takes you home — the same day. Keep the pinhole clean and dry for a couple of days: showers are fine, no baths, pools, or hot tubs for 48 hours, and no heavy lifting or strenuous activity for a few days. You go home with your after-care instructions and the on-call doctor’s cell phone number. Not an answering service — the doctor. And the next day, we call you to check on you. Every patient, every time.

The angiography suite at ARV Centers: imaging equipment and procedure table — **Where it happens** Our own interventional radiology suite, in our office — not a hospital operating room.

A man sitting up on a clinic recovery bed with an IV line, holding a glass of water and smiling — **Afterward** About an hour in recovery with us — then your driver takes you home, the same day.

Call our office if

Pain isn’t controlled by your medication · pain, a hard lump, or worsening bruising at the pinhole · fever above 101°F or chills · redness or warmth spreading from the site · new swelling of the testicle.

Go to the ER now if

Sudden, severe testicular pain — this can mean a twisted testicle, which is an emergency · bleeding at the pinhole that won’t stop with pressure · chest pain or shortness of breath · signs of a serious allergic reaction.

The weeks after — typical patterns, not promises:

Days 1–2	Most men are back to normal activity. Some soreness at the pinhole. In the one study that measured it, average time off work was 1.5 days.³
First week	Mild aching or a pulling sensation on the treated side is normal as the veins seal.
Weeks 2–6	The heaviness and the ache ease as the pooled blood clears and the veins shrink back down.
Months 3–6	If fertility was the reason, this is when repeat semen testing is usually done.

The published evidence

What the numbers show — and which question each one answers.

7 in 10

Men treated for a painful varicocele whose pain resolved, or eased enough that they were satisfied — at a median follow-up of 44.5 months, in a series of 182 procedures.² This is the pain number. Not a six-month result.

1.5 days

Off work after embolization, against 6.8 days after microsurgery, in the one prospective study that measured both. Post-procedure pain was lower too — 22% vs 44% of men with more than mild pain.³

96%

Technical success — the vein successfully closed — across 225 men in a 15-year, two-center series, with a complication rate of 1.78%.¹ This is the plumbing number, not the pain number. Different question, different figure.

6 in 100

Varicoceles confirmed back on ultrasound, at an average of about 34 months.¹ And among men whose varicocele reappeared on ultrasound, only about 1 in 6 had their pain come back.² We treat the man, not the scan.

2,138 men

Pooled across 16 studies comparing the catheter route with surgery head-to-head. Recurrence and pregnancy rates came out statistically indistinguishable — for embolization specifically, RR 0.90 and RR 1.02.⁵ The 76-man study behind the recovery figure is one of those sixteen, not a separate finding.

A third fewer

Adverse events after the catheter route than after surgery, in that same pooled analysis — RR 0.63.⁵ Read it as the route, not as us: it counts embolization and sclerotherapy together, and the surgery it’s measured against is a mix of open, laparoscopic and microsurgical repair.

What the numbers don’t say: 96% describes whether the vein closed — 7 in 10 is the pain figure, and roughly 3 in 10 men did not get the relief they came for. Complications counted more inclusively run higher than 1.78% — 10.45% in the pain series, all self-limited, most commonly a small tear in the vein during the procedure (about 3%) that settles on its own.² Both numbers are honest; they count differently, and we’d rather show you both than pick the flattering one.

Where the pooled comparisons land. Two analyses have pooled the studies comparing the catheter route with surgery, and they disagree about recurrence: the 2022 one, 16 studies and 2,138 men, found no difference between the routes;⁵ a larger 2025 analysis of 30 studies found varicoceles came back modestly more often after the catheter route — odds ratio 1.37.⁶ They agree on the other half. Both found fewer complications after the catheter route, and the 2025 one found far less of the fluid collection around the testicle that surgery sometimes causes.⁶ Two things neither one settles: pain, which no study has ever measured with both treatments side by side in the same men — which is why you won’t see surgery’s pain numbers printed next to ours — and microsurgery specifically, which neither pool isolates; the surgery counted in them is a mix of surgical routes. Microsurgical repair still has the lowest recurrence rate of any route, and it’s the one to ask a surgeon for.

Sources: 1. de Grae MNM, Al-khattab M, Alkadhimi A, Springael M, O’Sullivan G. A fifteen-year retrospective analysis of varicocele embolization: evaluating success, recurrence rates and embolic agents. CVIR Endovasc 2025;8:59 — 225 patients, two centers, 2008–2023; technical success 96%; clinical success 93.75%; ultrasound-confirmed recurrence 6.25% at 34 ± 17.7 months; complications 1.78%; indications pain 68%; no significant outcome difference between embolic agents. 2. Haroun P, Murgo S, Mjaess G, et al. Percutaneous embolization for painful varicocele: an 8-year tertiary centre experience. J Belg Soc Radiol 2025;109(1):2 — 182 procedures; technical success 88.15%; clinical success for pain 70.42%; median follow-up 44.5 months; complications 10.45%, all self-limited; pain recurrence in 17.24% of ultrasound recurrences. 3. Bou Nasr E, Binhazzaa M, Almont T, et al. Subinguinal microsurgical varicocelectomy vs. percutaneous embolization in infertile men: prospective comparison of reproductive and functional outcomes. Basic Clin Androl 2017;27:11 — 76 men (49 microsurgery, 27 embolization); spontaneous pregnancy 36.7% vs 33.3% (ns); sick leave 6.8 vs 1.5 days (p=0.002); pain >2/5 in 44% vs 22% (p=0.007); complications 3 vs 0. 4. American Urological Association / American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline (2020; amended 2024) — recommendations paraphrased, not quoted; prevalence figures as cited there. 5. Liu Q, Zhang X, Zhou F, Xi X, Lian S, Lian Q. Comparing endovascular and surgical treatments for varicocele: a systematic review and meta-analysis. J Vasc Interv Radiol 2022;33(7):834–840 — 16 studies, 2,138 patients; recurrence RR 1.03 (95% CI 0.78–1.36); pregnancy RR 1.03 (0.85–1.25); adverse events RR 0.63 (0.42–0.93, P=.02); embolization subgroups recurrence RR 0.90 (0.55–1.47) and pregnancy RR 1.02 (0.79–1.30); adverse events not reported separately for embolization; semen parameters not analyzed; comparator surgery a mix of open, laparoscopic and microsurgical repair. 6. Chen H, Liu K, Liu M, Jin T, Zhou L. Comparison of sclero-embolization and surgical ligation for varicocele treatment: a systematic review and meta-analysis. World J Urol 2025;43 — 30 studies; recurrence OR 1.37 (1.03–1.82); overall complications OR 0.65 (0.47–0.91); hydrocele OR 0.19 (0.10–0.35). 7. Owen RC, McCormick BJ, Figler BD, Coward RM. A review of varicocele repair for pain. Transl Androl Urol 2017;6(Suppl 1):S20–S29. 8. Park JH, Pak K, Park NC, Park HJ. How can we predict a successful outcome after varicocelectomy in painful varicocele patients? An updated meta-analysis. World J Mens Health 2021;39(4):645–653.

Candidacy

Who this is for — and who it isn’t.

The full “how we decide” — the standing exam, the ache that fits, every option — is on the varicocele page. The short version:

A doctor in a white coat shaking hands with a patient in an exam room — **A straight answer either way** The consultation decides this — and if surgery is genuinely your better option, we’ll say so and help you get there.

Embolization may be right for you if:

Your main problem is the ache — dull, heavy, on one side, worse standing or by the end of the day, better lying down — and it’s affecting your life
The varicocele can be felt on a standing examination, and it explains what you came in for
You’ve given scrotal support and anti-inflammatories a fair run — usually a few months — and you’re still aching
You want to avoid an incision and a general anesthetic, or you can’t take a week off work
You have one on each side — embolization treats both through one pinhole
You’ve already had surgery and it came back — one of embolization’s classic uses: no new incision through scarred tissue, and the map shows exactly which branch was missed

It may not be right if:

Your varicocele can’t be felt and shows only on a scan — especially if fertility is the concern. The guidelines advise against treating it,⁴ and we follow them
Your pain is sharp, burning, or radiating, or it’s the same lying down — that points somewhere else, and we’d rather find the real cause than treat the vein we happen to be able to treat
You’re trying to conceive and haven’t yet seen a urologist or a fertility specialist — that conversation belongs first, and we’ll help arrange it
You haven’t tried the simple things yet — support and anti-inflammatories deserve a fair run first, and it costs you nothing to find out
You have an active infection, significantly impaired kidney function, or you’ve had a serious reaction to X-ray dye

We turn men away who aren’t candidates for what we do. If surgery is genuinely your better option, we’ll say so — and help you get there.

Your care team

The doctors who perform varicocele embolization here.

Varicocele embolization at ARV Centers is performed by Board Certified Vascular and Interventional Radiologists — and we’re glad to coordinate with your urologist before and after. Many stay involved in your care.

Samy A. Al-Bayati, M.D.

Board Certified ·
Vascular & Interventional Radiology

English/Arabic

Arthur S. Joseph, D.O., M.P.H.

Board Certified ·
Vascular & Interventional Radiology

Andrew V. Chesley, M.D.

Board Certified ·
Vascular & Interventional Radiology

English/Español

Meet the whole team →

After your procedure

You go home with the doctor’s cell number.

When you go home, you take the on-call doctor’s cell phone number with you. Not an answering service — the doctor.

And you don’t have to wonder whether to bother us: we call you the next day to check in. Every patient, every procedure. Most men who come to see us about this have been carrying it for years, quietly. The least we can do is not leave you alone with it afterward.

Before you leave, you’ll get this card

Your procedure:

On-call doctor:

Cell phone: written by hand, before you walk out

Call me if anything worries you.

Straight answers

Questions patients actually ask.

“Does it hurt?”

The procedure itself, no — you’re sedated and comfortable, the pinhole — at the groin or the neck — is numbed, and most men describe pressure rather than pain. Afterward, expect some soreness at the pinhole and a dull ache or pulling on the treated side for a few days as the veins seal. You go home with a plan for it, and with the on-call doctor’s cell number if it isn’t behaving.

“Will I be awake?”

You get IV sedation — relaxed and drowsy, breathing on your own. Not general anesthesia. No breathing tube, no operating room. It is still sedation, so you’ll need a driver to take you home — no exceptions.

“The coils — can they move? Will I feel them? What about an MRI?”

The coils are small, soft, and permanent, and they sit inside a vein high in your abdomen — not in your scrotum, not against the testicle. They’re sized to the vein and anchor as it seals around them; migration is a recognized but uncommon complication your physician will go through with you. Some men online report feeling them; most feel nothing at all — and we’re not going to tell you nobody ever has. Airport scanners: no. MRI: the coils are MRI-compatible, but always tell the technologist what’s in you.

“Will it affect my sex life?”

Nothing is done to the testicle, to the nerves that control erection, or to the structures involved in ejaculation. The whole procedure happens inside a vein in your abdomen, well above the scrotum.

“Can both sides be done at once?”

Yes — one session, one pinhole. Surgery generally means a second incision, or a laparoscopic approach under general anesthesia. Treating both sides in one sitting is one of the places embolization is at its most useful.

“Can it come back?”

Sometimes. In the 15-year series, about 6 in 100 varicoceles were confirmed back on ultrasound, at an average of just under three years.¹ Here’s the more interesting number: among men whose varicocele was found again on ultrasound, only about 1 in 6 had their pain come back.² The picture and the symptom come apart. If it does come back and it bothers you, it can usually be treated again. Against surgery, the pooled comparisons split: one analysis of 16 studies found no difference in recurrence,⁵ a larger one of 30 studies found it modestly more common after the catheter route.⁶

“What if the vein can’t be reached?”

It happens — in about 4% of cases in one large series¹ and about 12% in another.² The vein is attempted, it can’t be catheterized safely, and the procedure is stopped without anything being closed. You should know before you consent that this is possible. If it happens to you, nothing has been lost: surgery remains fully open to you, and we’ll help arrange it.

“Why didn’t my urologist mention it? Is it experimental?”

It isn’t experimental — doctors have been closing testicular veins this way since the late 1970s, and there are published series following patients for 15 years.¹ The reason you may not have heard of it is that it isn’t performed by urologists. It’s performed by interventional radiologists — a different specialty, with a different referral network. Your urologist trained in an operating room, and when a man walks in with a varicocele, the treatment that comes to mind is the one that specialty performs. That’s not dishonesty; it’s how medicine is organized. And for a man trying to conceive, the American guidelines name surgery — your urologist would be following them.⁴

“What if I’d rather have surgery?”

Then that’s what you should have, and we’ll help you get there — we refer for it routinely. If you’re trying to conceive, it may well be the better choice. One thing worth asking any surgeon: will it be done with an operating microscope? Microsurgical repair has the lowest recurrence rate of the surgical routes.

“Is it covered by insurance?”

Varicocele embolization is covered by most insurance plans, and we’re in-network with most plans. We do a complimentary benefits check before any procedure is scheduled — usually on the day of your consultation. No surprises. If cost is the obstacle, say so: we offer Affirm, CareCredit, and in-house payment arrangements.

“Do I need a referral?”

Not for your initial consultation — call us directly. If your plan requires a referral or prior authorization for treatment itself, we’ll identify that during the complimentary benefits check and help you get it. And we’re glad to coordinate with your urologist before and after; many stay involved in your care.

Free patient guide

Not ready to call? Read the guide instead.

Varicoceles: Every Option You Have — a 25-page, plain-English guide written by our physicians: what a varicocele is and why it aches, every treatment side by side — including the ones we don’t perform — what the studies actually found, who each option is wrong for, and the questions to ask any doctor, including us. No appointment required, and no follow-up phone call unless you ask for one.

We’ll email your guide plus occasional patient education. Unsubscribe anytime. Privacy policy.

Bring the story. You’ll be examined standing, by a physician — and you’ll leave knowing exactly what’s there, every option you have, and what we’d do if you were family.

Bring your imaging if you have it, and the short version of who you’ve seen and what they said. Call us directly, or send this form and we’ll call you to schedule. We do a complimentary benefits check before any procedure. No surprises. Want a head start? Download the varicocele consultation packet and fill it in at home.

210-405-1335

Consultation hours

Monday–Thursday8:00–5:00
Morning · last consult11:30 AM
Afternoon · last consult4:30 PM
FridayProcedures only

Closed on major holidays.

3212 Napier Park, San Antonio, TX 78231

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