Neck or groin access for varicocele embolisation: Is it important?

Abstract

Varicocele embolisation is an excellent treatment option for symptomatic scrotal varicosities. The purpose of this study was to assess the current practice of the endovascular treatment of left-sided varicoceles at our institution, to compare the findings to international standards and to identify which access site reduces screening time and radiation dose. All left-sided varicocele embolisations over a 4-year period were identified and analysed with regards to technical success, complications and recurrence rates. The results were analysed with regard to the encountered anatomy on a case-to-case basis to identify anatomical factors influencing the outcome of the procedure. During the study period 95 primary left-sided varicocele embolisations were performed by two experienced consultants. Five cases had a normal initial venogram (Type 0) and further five had unsuitable anatomy for embolisation. Eighty-three of the remaining 85 attempted embolisations were technically successful (98% technical success rate). The clinical success rate was determined by recurrence, which was documented in five cases (mean follow-up 34.3month, 6% recurrence rate). Recurrence was associated with more complex local anatomy (Type 3 and Type 4). The overall findings were consistent with international published standards for technical success rate (95-100%) and recurrence rates (1.6-10%). Complication rates were low with extravasation being reported in 4.7% (all self-limiting) and temporary pain in 3.5% of the cases. There was no significant difference in radiation dose/screening time, success or complications when comparing a groin versus neck approach to the embolisation procedure (P>0.05). Varicocele embolisation is successful with a low complications rate. Neck and groin access are equally successful with no significant difference in screening time.