Varicocele embolisation

This leaflet is intended for patients who have been advised to have a varicocele embolisation.

What is a varicocele embolisation?

A varicocele is an abnormality of the veins that take blood away from the testicle. The veins become bigger and more obvious like varicose veins in the leg. Embolisation is a way of blocking these veins using x-ray guidance. It makes the veins less obvious and causes the varicocele to disappear without an operation.

Why do I need a varicocele embolisation?

Varicoceles can cause various problems, including discomfort and swelling. There may also be an association with infertility. In the past, an open operation would have been necessary to get rid of the varicocele. It can now be treated by the technique of embolisation.

Who has made the decision for me to have a varicocele embolisation?

The consultant in charge of your case and the radiologist performing the varicocele embolisation will have discussed the situation and concluded that this is the best way of treating your condition. Your opinion will be considered. If, after discussion with your doctors, you do not want the procedure to be carried out, you can decide against it.

What are the benefits?

The aim of varicocele embolisation is to treat your symptoms of pain and discomfort, or to attempt to improve your fertility.

What happens before the procedure?

You will be asked to attend the hospital and be admitted to the Radiology Day Unit (RDU).

• A doctor will take a history from you.
• You may have a small needle put into a vein in your arm for painkillers to be given if necessary.
• Standard blood tests may be carried out.
• You can eat and drink as normal.
• You may be given antibiotics on the morning of the procedure.
• If you have any allergies, you must let your doctor know.
• If you take any medications to thin the blood (anticoagulants or antiplatelets) please let us know beforehand, as these will need to be stopped a certain length of time before the procedure.
  • Examples include: warfarin, dalteparin, enoxaparin, tinzaparin, dabigatran, rivaroxaban, apixaban, clopidogrel, ticagrelor.
  • Low dose aspirin (75mg) is safe to continue.
  • Please discuss with a doctor before stopping any medicines, as sometimes other treatment will need to be given.
• If you have previously reacted to intravenous contrast medium (the dye used for computed tomography [CT] scans), you must also tell your doctor about this.

Who will be performing the procedure?

The varicole embolisation will be performed by a specially trained doctor called an interventional radiologist. These radiologists are experts in using x-ray equipment to interpret the images produced. The radiologist will look at these images while carrying out the procedure, and will be assisted by a radiographer and a nurse.

What happens during the procedure?

• You will be dressed in a hospital gown.
• You will lie on the x-ray table, generally flat on your back.
• You will have a monitoring device attached to your finger, and will have a blood pressure cuff placed around your arm.
• The procedure is performed under sterile conditions. The radiologist and scrub nurse will wear sterile theatre gowns and operating gloves.
• Most often a vein in the groin is used, but occasionally a vein in your neck or arm will be chosen. Your doctor will tell you beforehand which vein will be used. Your skin will be cleaned' and local anaesthetic given to numb the area and prevent any pain. A small tube is then placed into the vein.
• A small guide wire and a fine plastic tube (a catheter) will be inserted into the vein using x-ray guidance.
• When pictures need to be taken, some iodine dye will be injected. You will be asked to hold your breath for a short time at these points. You may feel a hot sensation from the dye, and it can make your bladder feel full.
• Once the catheter is in the right place, the abnormal veins will be blocked. The radiologist can block the abnormal veins by passing small metal coils, like small springs, down the catheter. These coils cause the blood around them to clot and so block the vein.
• After the veins are blocked, you will return to a hospital bed.
• The tube in the vein will be removed and pressure applied on the site for several minutes to prevent any bleeding.

Will the varicocele embolisation hurt?

Some discomfort may be felt in the skin and deeper tissues during injection of the local anaesthetic. You may feel a warm sensation for a few seconds when the x-ray dye is injected. Some people report a metallic taste in the mouth. You may also feel like you are passing urine; this is normal.

For many patients, this procedure is not painful. Following the procedure, you may get pain in the testicle like the pain from your varicocele. Some people also get some abdominal pain. This pain is usually mild and controlled with simple painkillers. Sometimes this pain can last four or five days.

There will be a nurse, or another member of the clinical staff, in the room looking after you. If the procedure does become uncomfortable, please let a member of staff know.

How long will the procedure take?

Every patient’s situation is different and it is not always easy to predict how complex or how straightforward the procedure will be. Generally, the procedure will last one hour. As a guide, you will be in the x-ray department for approximately three to four hours before discharge.

What will happen after the procedure?

You will be taken back to the RDU for observations and a period of bed rest. Nursing staff will carry out routine observations including taking your pulse and blood pressure readings and will check the treatment site.

If you experience pain, sickness, abnormal swellings or are generally feeling unwell, please let the nursing staff know.

You will need to stay in bed for up to two hours to allow you to recover.

What are the possible risks?

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

• There may occasionally be a small bruise (a haematoma) around the site where the needle has been inserted. This is quite normal. If this becomes a large bruise there is the risk of it getting infected. This would then require treatment with antibiotics.
• It is not always possible to position the catheter into the abnormal vein. If this is the case, embolisation will not be possible.
• Very rarely, some damage can be caused to the vein by the catheter. This may need to be treated by surgery or another radiological procedure.
• Unfortunately, although the varicocele may seem to have been cured initially, it may come back again months, or even years, later. If this happens, the procedure may need to be repeated, or you may be advised to have an operation.

Radiation

You have been referred for an interventional radiology procedure to help deliver your treatment. A specialist in radiology agrees that this is the best procedure to treat your clinical condition and that the benefit of the examination is greater than the risk.

• The x-ray involves a dose of ionising radiation equivalent to a few months or years of natural background radiation, to which we are all exposed every day. The dose delivered will be kept as low as is practicable.
• Ionising radiation can cause cell damage that may turn cancerous; however, the risk of this happening from your examination is considered low.
• Depending on the duration of the procedure, there may also be a small risk of an excess radiation dose to the skin leading to short-term and long-term effects (for example, reddening of the skin and burns). If this happens as a result of this procedure, you will receive further advice.

For further information, please visit this page on our website.

Conclusion

Some of your questions about your procedure should have been answered by this leaflet, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you.

Make sure you are satisfied that you have received enough information about your treatment. You can obtain more information from the British Society of Interventional Radiology (BSIR).

This document has been adapted from one prepared by the BSIR.

Privacy and dignity

We are committed to treating all patients with privacy and dignity in a safe, clean and comfortable environment. This means, with a few exceptions, we will care for you in same-sex bays in wards with separate sanitary facilities for men and women.

In some areas, due to the nature of the equipment or specialist care involved, we may not be able to care for you in same-sex bays. In these cases, staff will always do their best to respect your privacy and dignity, for example with the use of curtains or, where possible, moving you next to a patient of the same sex. If you have any concerns, please speak to a member of the imaging team, ward sister or charge nurse.