Radiation Exposure During Varicocele Embolization: Does Access Site and Treated Side Matter?

Background: This study aims to evaluate radiation exposure during varicocele embolization and correlate it with access site and embolized side. Method(s): This retrospective study included 39 patients who underwent varicocele embolization between Jan 2015 to Dec 2018. Embolization was done in all cases using a combination of coils and sclerosing agents in Sandwich technique. Bilateral embolization was done in 13 patients, while only the left side was embolized in 26 patients. Jugular vein access was used in 10 patients, while the brachial and basilic veins were used in 14 and 15 patients, respectively. Dose area product (DAP) and total fluoroscopy time were collected and correlated to the treated side and access. Statistical analysis was done on (StatPlus:mac, AnalystSoft Inc.,Version v6) using wilcoxon and kruskal-wallis tests. Result(s): The mean fluoroscopy time for left varicocele embolization was 26.76 minutes (8.23 minutes – 49.6 minutes), which was not statistically different (p=0.16) compared to bilateral embolization mean fluoroscopy time of 33.2 minutes (10.3 minutes – 58.83 minutes). There was no statistical difference (p=0.37) between the mean DAP for left varicocele embolization of 106239 mGy.cm² 12672–590429) compared to bilateral DAP of 107153 mGy.cm² (29593–257259). There was no significant difference (p= 0.22) between the mean DAP when using different vascular access (Brachial, DAP= 149416 mGy.cm²), (Jugular, DAP= 87569 mGy.cm²) (Basilic, DAP= 79179 mGy.cm²). However, the basilic vein access was correlated with significantly shorter mean fluoroscopy time of 22 minutes (8.97 minutes – 42.5 minutes) compared to brachial vein (32 minutes, 8.23 minutes – 58.83 minutes) and jugular vein (34 minutes, 8.3 minutes – 49.6 minutes) with a p-value of 0.0429. Conclusion(s): The choice of vascular access may help in reducing fluoroscopy time during varicocele embolization, without significant difference between left or bilateral embolization. This reduction in fluoroscopy time did not translate into significant difference in DAP, which indicates the need for stricter radiation precautions such as collimation and less angiographic exposures.