Endovascular treatment of varicocoeles

An endovascular treatment of a varicocoele is a treatment that we perform along the blood vessels to treat a varicose vein in the testicle.

We do this using embolisation. This is a method to close off the varicocoele using a catheter (a small tube) so that no blood can pool in the vascular network around the testicle and so that well-functioning veins can take over the function of carrying blood away from the testicle.

The test is performed with guidance (radiological images, or X-rays) and is performed by an interventional radiologist, a specialist who has specialised training in performing these treatments.

Treatment may be requested by a urologist or fertility specialist, in consultation with the interventional radiologist, as well as after a clinical examination. An ultrasound of the testicle is also often performed.

• Minimally invasive method (skin incision of +/- 2 mm in the (right) groin that is just as effective (successful) as the surgical method.
• Performed using local anaesthesia
• Small chance of complications, lower than with surgery (operation)
• Performed as an outpatient admission
• Small chance of complications, lower than with surgery (operation)

A varicocoele embolisation is a very safe procedure, but, as with all treatments, there are certain associated risks:

• Every intervention where the skin is broken, for example, has a chance of infection.
• There is a possibility of allergic reaction to the iodine in the contrast agent. If you have had a previous reaction to contrast agent, please do not forget to tell the physician or nursing staff.
• Bleeding from the groin at the punture site. This is a temporary problem. The bleeding will stop on its own.
• Vague back and groin pain as a result of closing the 'defective' vein. This pain often lasts for a maximum of 24 hours, although can sometimes last for a week in exceptional cases. The sympoms can be brought under control with the help of a mild painkiller.
• Very rarely: there can be damage to the vein that was punctured with the catheter.
• Very rarely: there can be displaced embolisation material toward the non-defective veins.

The defective blood vessel can also be tied off using a surgical procedure using a skin incision or a keyhole surgery (laparascopy). You may see a urologist for more information.

Preparation for treatment

• Medication that influences coagulation (Aspirin, Clopidogrel, Warfarin, DOACs) must be stopped before the treatment. If you take this medication, contact the Radiology Department at least one week before the treatment.

• Medication for diabetes must be adjusted before the treatment. If you take this medication, contact the
  Radiology Department at least one week before the treatment.

• Are you allergic to certain materials (medications, latex, contrast agent)? Do not forget to check in for your admission.

• You must be fasting for this treatment:

Type of food:	Example:	Allowed until at the latest:
Normal meal		midnight before the surgery or examination
Light meal	e.g. a sandwich or toast with jam. Deep-fried/fatty foods or meat are not included	six hours prior to the procedure or examination
Dairy products	Milk, bottle-feeding for a child, yogurt...	six hours prior to the procedure or exam
Breastfeeding		four hours prior to the procedure or examination
Drinks	As wished: water, sugar water, sports drinks, clear fruit juices without pulp (apple juice, grape juice) Maximum a cup: clear tea and coffee without milk .	Recommended: continue to drink up to two hours before the procedure or examination (Exceptions: gastrointestinal surgery. You should follow the instructions of your attending physician). No milk products

Treatment

The treatment is performed in a room especially designed for this purpose (an angiography room), and that utilises X-rays.

• You will lie on your back during the treatment and you will be given a surgical gown to put on.
• Your groin will be shaved and disinfected, and your body will be covered with a blue, sterile sheet. The physician and the assisting nurse will also wear a sterile apron, mask and cap.
• After administering local anaesthetic to the groin, the inguinal vein will be punctured and a thin tube (catheter) will be introduced up towards the testicle into the defective vein.
• Contrast agent is used to visualise the vein and in order to make a clinical diagnosis. After receiving the contrast injection, you may feel warm and some patients have the feeling that they need to urinate.
• The vein will then be closed with a kind of adhesive. This may cause a brief, but very intense, burning and warm sensation that lasts for a couple of seconds.
• Afer closing the blood vessel, the catheter is removed from the groin and firm pressure is applied for five minutes.

The total duration of the procedure is approximately an hour.

In 5-10% of the patients who have a varicocoele, no varicocoele is seen after injecting contrast agent. It may also be the case that, given the complexity of the anatomy, no catheter can be placed in the 'defective' blood vessel: in this case, an embolisation cannot be performed and the varicocoele must be treated surgically.

After the treatment

After a short stay in the recovery room, you will return to the department to which you were admitted.
This is where you will be on bedrest for at least two hours and where the puncture site, blood pressure and pulse will be monitored.
Afterwards, you may carefully get ready and leave the hospital with an accompanying person.

• Take it easy for the rest of the day.
• Resume normal activities after 24 hours. Heavy physical exertion should be avoided for 48 hours.
• If you have a fever, please contact the Radiology Department.
• If you are worried or if you feel uncomfortable and think that a medical check is necessary, you may always contact the hospital's Radiology Department, your urologist, GP or the A&E.

Three months after the procedure, you will have a check-up by the referring physician and/or the interventional radiologist who performed the treatment.

Latest publication date: 23/01/2024
Supervising author: Dr Schoofs Christophe