Varicocele embolisation

Varicoceles can cause various problems including discomfort and pain, and may be associated with infertility. In the past, an open operation would have been necessary to get rid of the varicocele, but they can now be treated by an image guided minimally invasive procedure. The procedure is performed from inside the veins after making a tiny nick in the skin.

The procedure will be conducted in an angiography suite (“cath lab”) at Intra, which is in the Mercy Hospital at 98 Mountain Road, Epsom in Auckland. Your interventional radiologist will be assisted by nurses and other highly trained staff.
 

• You will lie flat on the x-ray table.
• You need to have a small plastic cannula put into a vein in your arm so you can be given a sedative or painkillers.
• You may also have a monitoring device attached to your chest and finger, and may be given oxygen through small tubes in your nose.
• The radiologist will keep everything as sterile as possible, and wear a theatre gown and operating gloves.
• The skin around the point of insertion (the neck or groin) will be swabbed with antiseptic, and then the area covered with a theatre towel.
• The skin and deeper tissues over the vein will be anaesthetised with local anaesthetic that can sting for a few seconds. 
• A small plastic tube is placed into the vein and through this a smaller plastic tube, called a catheter is placed over a wire and into the testicular vein.
• The radiologist uses the x-ray equipment to make sure that the catheter and the guide-wire are moved into the right position, into the varicocele, and then the wire is withdrawn.
• A small amount of special dye, called contrast medium, is injected down the catheter to check the abnormal veins.
• The radiologist can block the abnormal veins usually by injecting a special fluid or foam down the catheter. The fluid / foam causes the vein to close down, and consequently block the vein.
• The catheter and foam will be left in place for up to 10 minutes to ensure the veins block completely, and the catheter is removed. The radiologist will press firmly on the skin entry point for several minutes, to prevent any bleeding.

Generally, the procedure will be over in about an hour but every patient’s situation is different. You may be in the cath lab for a couple of hours.

In some patients who have different anatomy or only a small varicocoele, it may not be possible to catheterise the vein coming from the testis. If this is the case it will not be possible to treat the veins in the scrotum and the procedure will only provide diagnostic information to consider other forms of treatment (open or micro-surgery).

• You will be awake during the procedure and able to tell the radiologist if you become uncomfortable.
• There will be a nurse, or another member of staff, standing next to you and looking after you. If the procedure does become uncomfortable for you, then they will be able to arrange for you to have some painkillers through the cannula in your arm. 
• It will sting for a few seconds when the local anaesthetic is injected into the skin and deeper tissues over the vein. The skin and deeper tissues should then feel numb.
• Some patients can feel a dull ache in the lower back or testicles, when the vein is stretched but this passes off after a short time.

• Fasting: You will be asked not to eat for four hours before hand, though it is all right for you to drink a small amount of clear water.
• Allergies or previous reactions to contrast (x-ray dye): If you have previously reacted to intravenous contrast medium, the dye used for CT scanning, then you must also tell your doctor about this. Also, if you have any allergies, you must let your doctor know. Please also let the staff at Intra know of any allergies or contrast reactions at the time of booking your procedure.

You may receive a sedative to relieve anxiety.

You will be asked to put on a hospital gown as the procedure is carried out using the larger veins in the neck or groin.
 
On the day of your procedure, please make your way to the Mercy Hospital Reception where they will be expecting you. You will be admitted to a Mercy Hospital ward and transferred to Intra for your procedure.

The procedure is performed as a day stay, and you can go home after 2 – 4 hours observation. You are encouraged to bring friend or family member as you cannot drive after having your procedure.

For directions to the Mercy Hospital, click here.

• You will be taken back to the recovery area and be able to sit up.
• The nurses will carry out routine observations, such as taking your pulse and blood pressure.
• They will also look at the skin entry point to make sure there is no bleeding from it.
• You will generally stay in bed for a few hours, until you have recovered when you will be allowed home. 
• You cannot drive or operate machinery after having medication through the arm vein. While you should continue to walk and undertake light activities you are asked to avoid any vigorous exercise or heavy lifting for at least 5 days to allow the inflammation in the vein to settle down and stop the vein from re-opening.

The veins in the scrotum (varicocele) slowly disappear in most patients over the next 8 – 12 weeks, in a minority of patients some small veins remain but symptoms improve in the over 90% of patients.

Varicocele embolisation is a very safe procedure but as with any procedure there are some risks and complications that can arise:

• There may occasionally be a small bruise, called a haematoma around the site where the needle has been inserted, and this is quite normal. If this becomes a large bruise then there is the small risk of infection, and this would then require treatment with antibiotics.
• In a small number of patients the liquid/foam used to close down the vein can irritate the veins around the testicles in the scrotum and this can result in discomfort or pain for a few days. This usually goes away with simple painkillers (paracetamol or ibuprofen). This does not cause any injury to the testicle.
• Unfortunately, there is always the possibility that although the varicocele seems to have been cured to start with, months or even years later, it may come back again. If this happens the procedure may need repeating, or you may be advised to have an operation.

Despite these possible complications, the procedure is normally very safe, and is carried out with no significant side effects at all.

Varicocele embolisation is considered a very safe procedure, designed to prevent you having a larger operation. There are some slight risks involved however they are generally minor and occur infrequently.