Comparison of Two Percutaneous Approaches in Varicocele Embolization: Study of Complications, Radiations and Recurrence Rate

Abstract
Background: In this retrospective study, we will compare two approaches in percutaneous embolization of varicocele, right common femoral vein access and right internal jugular vein access, we will compare technical success, complications and recurrence rate.
Aim of the Study: This study constructed, to compare two percutaneous access routes in varicocele embolization, the transfemoral and the jugular routes. It was a comparison of complications, radiations and recurrence rates.
Patients and Methods: This study was retrospective study of the records of 34 male patients with clinically and radio-logically proved varicocle who were treated by percutaneous embolization, in the period from 2014 to 2016. They included two groups, Group I (17 patients) treated using the transfemoral route and Group II (17 patients) treated using jugular route. The embolic materials used included, coils (14 patients), N-butyl-2-cyanoacrylate (12 patients) and sclerosing agents or polidocanol in 8 patients. The catheters used were cobra head-5-Fr, Bern 4Fr and microcatheter (progreat 2,7F). The com-plications, time of radiation, technical success and recurrence were compared in both groups.
Results: In Group I (percutaneous transfemoral route), there was failure of catheterization of right internal spermatic vein in one patient due to acute angle, while in Group II there was successful catheterization of left and right internal sper-matic vein in all (17 patients). Also, post-procedural pain was seen in 3 patients in Group I and in 2 patients in Group II. Contrast extravasation was seen in one patient in Group I, groin hematoma in 2 patients, glue migration in one patient and recurrence in 2 patients, while in Group II no vein injury, no hematoma or glue migration and recurrence was seen in one patient only. The mean procedure time and the fluoroscope time were longer in Group I as compared to Group II. In Group I the mean procedure time was 52 minutes and fluor-oscopy time was 23 minutes while in Group II. They were 40 minutes and 15 minutes respectively.
Conclusion: Percutaneous embolization of varicocele is relatively safe technique and has high success rate. The percutaneous transjugular route is easy for catheterization of both right and left internal spermatic vein, while for left sided varicocele, the right common femoral vein access is easy and safe. The transjugular route has less complications, less radiation time and low recurrence rate.