title: Neck or groin access for varicocele embolisation: Is it important?
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 34.3 month, 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).
  
  
  CONCLUSIONS
  Varicocele embolisation is successful with a low complications rate. Neck and groin access are equally successful with no significant difference in screening time.
authors.affiliation: Department of Radiology, Churchill Hospital, Headington, Oxford, UK.
authors.forename: Philipp
authors.initials: P
authors.lastname: Riede
authors.affiliation: Department of Radiology, Churchill Hospital, Headington, Oxford, UK.
authors.forename: Eoghan
authors.initials: E
authors.lastname: McCarthy
authors.affiliation: Department of Radiology, Churchill Hospital, Headington, Oxford, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Cary
authors.affiliation: Department of Radiology, Churchill Hospital, Headington, Oxford, UK.
authors.forename: Phil
authors.initials: P
authors.lastname: Boardman
authors.affiliation: Department of Radiology, Churchill Hospital, Headington, Oxford, UK.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Tapping
mesh_terms: D004621:Embolization, Therapeutic / Q000379:methods* / Q000592:standards; D006119:Groin; D006801:Humans; D008297:Male; D009333:Neck; D010690:Phlebography; D012008:Recurrence; D014646:Varicocele / Q000628:therapy*
keywords: infertility; scrotum; varicocele embolisation; veins