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.
Nutcracker syndrome is one of the causes of secondary pelvic congestion syndrome.