Microsurgical Varicocelectomy for Challenging Periarterial Veins: Transfixion of Artery-adherent Veins and En Bloc Ligation of Venous Bundles

Y. Zhang, Y. Ding, H. Zhang

Varicocelectomy, Transfixion, En bloc ligation

Microsurgical varicocelectomy is the gold-standard treatment for clinically significant varicocele. One of the most challenging steps is the management of periarterial veins, which may be tightly adherent to the testicular artery or form clustered venous bundles with minimal dissection planes. In such cases, conventional techniques risk arterial injury and prolong the procedure. We demonstrate two alternative microsurgical approaches: 1.Transfixion of artery-adherent veins – When one or more veins are firmly adherent to the testicular artery, precluding safe separation, they are controlled with a fine transfixion suture under high magnification, thereby preserving arterial integrity. 2. En bloc ligation of venous bundles – When multiple periarterial veins lack clear dissection planes but are distinctly separated from the artery, once the artery has been isolated, 2–3 adjacent veins (sometimes more, depending on anatomy) are ligated simultaneously as a bundle, simplifying the procedure. These alternative techniques provide safe and efficient solutions for distinct periarterial challenges encountered during microsurgical varicocelectomy. By tailoring the approach—transfixion for artery–vein adhesion and en bloc ligation for venous bundles—surgeons can preserve arterial integrity while improving procedural efficiency.

None.

The authors have nothing to disclose

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