Abstract
<jats:p>Varicocele and chronic venous insufficiency (CVI) are typically managed in separate clinical pathways, yet both arise from a shared hemodynamic problem: a low-pressure venous system that fails to maintain efficient, unidirectional drainage under reflux, hydrostatic load, venous wall remodeling, and chronic inflammation. In varicocele, the affected territory is the pampiniform plexus and internal spermatic veins, with consequences for fertility, endocrine function, and scrotal discomfort. In CVI, the burden is lower-limb venous hypertension, presenting with heaviness, edema, varicosities, skin changes, and ulceration. These disorders are distinct, but their shared biology is clinically relevant. Patients with varicocele may exhibit a broader venous phenotype, including lower-extremity symptoms or saphenofemoral incompetence, while patients with CVI may also harbor clinically relevant varicocele. This chapter presents a unified, pragmatic framework through three lenses. The clinical perspective addresses presentation, overlap, and patient selection. The pathophysiologic perspective highlights venous hypertension, endothelial dysfunction, oxidative stress, hyperthermia, hypoxia, and end-organ damage. The therapeutic perspective integrates observation, semen- and symptom-guided microsurgical varicocelectomy, percutaneous embolization, duplex-guided superficial venous interventions, and selected deep venous strategies. The core message is practical: Routine cross-screening is unnecessary, but coexistence should be considered in bilateral, recurrent, atypical, or treatment-resistant cases. A treatment approach that aligns fertility goals, pain, limb symptoms, anatomy, and hemodynamics may reduce overtreatment and recurrence while improving patient-centered outcomes.</jats:p>