Testicular Vein (Varicocele) Embolisation in Cyprus
A varicocele is an abnormality of the veins that take blood away from the testis. The valves in the veins do not work properly and so the veins become bigger (dilate) and can cause the following:
- Groin/scrotal pain
- Testicular swelling
- Infertility
Benefits
Testicular Vein Embolisation is a procedure in which Dr Zertalis uses ultrasound (US) and X-Rays (fluoroscopy) to navigate a fine tube (catheter) into the abnormally dilated blood vessel (testicular vein) draining the testicle followed by injection of small metal coils aiming at blocking and shrinking the vein thus providing symptomatic relief. There is scientific evidence to support high technical and clinical success of the procedure (up to 96%).
Risks
Testicular vein embolisation is a safe, effective and accurate procedure, but as with any medical procedure there are some risks and complications that you may uncommonly experience.
Pain: Some patients may experience groin or loin discomfort for a few days after the procedure.
This can be well controlled with painkillers.
Bleeding: Risk of bleeding that is significant is extremely rare. Uncommonly you may get a small bruise at the needle entry point in the groin or neck.
Infection: Testicular vein embolisation requires direct access to the bloodstream hence there is a very small risk of infection.
Non-target embolisation: Rarely a coil may move out of position and migrate to the lungs. In this instance an attempt will be made to retrieve the coil. Failure to do so is unlikely to cause any problems other than a cough and/or chest pain for up to a week after the procedure.
Allergy to contrast (X-ray dye): Most adverse events are mild and can be managed safely in our department. A major life-threatening contrast reaction is rare (< 0.005%).
Kidney Impairment: Impairment of kidney function can occur following the treatment due to the contrast agent or dehydration. You will have a drip placed before the procedure. This is to give you sufficient fluids to minimise the risk of problems with kidney function.
Radiation Risk: Immediate harmful effects such as skin burns, or radiation sickness are rare. The radiation dose you receive during the procedure is monitored to prevent this. On rare occasions the procedure will have to be stopped if the threshold for immediate harmful effects is reached. Increase in lifetime risk of cancer due to radiation per examination is also rare (< 0.001%).
Failure: There is scientific evidence to support high technical and clinical success of the procedure. Unfortunately in < 10% of patients symptoms may recur and a repeat procedure or surgery maybe necessary. Dr Zertalis will organise a follow-up appointment 1 month after the procedure and an US scan in 3-6 months to evaluate the outcome of the procedure.
Dr Zertalis will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and remember that even at this stage, you can still decide not to go ahead with procedure if you choose to do so.
Before the procedure
The procedure is performed under local anaesthetic and sedation. You will be asked not to eat or drink for 6 hours before the procedure. Where necessary a blood test may be required. A short and thin plastic tube (cannula) will be placed into a vein in your arm.
Please let Dr Zertalis know about any medications you take, any allergies you may have and if you previously have had a reaction to the x-ray dye (contrast).
The procedure
You will be asked to change into a hospital gown and lie on the X-ray table flat on your back. You will have devices attached to your chest, arm and finger to monitor you pulse, blood pressure and oxygen levels. You will be given a sedative to relieve anxiety. This is standard for all minimally invasive interventional radiology procedures performed in Cyprus.
The procedure is performed under sterile conditions and Dr Zertalis will wear sterile gowns and gloves. The skin near the point of insertion at the top of the leg (usually the right groin) or the neck (depending on patient preference) will be cleaned with antiseptic and you will be covered with sterile drapes.
Dr Zertalis will use ultrasound to inject local anaesthetic and place a fine plastic tube (vascular sheath) into the vein in the groin (common femoral vein) or into the vein in the neck (jugular vein).
Dr Zertalis will use X-ray equipment to navigate and guide another fine plastic tube (catheter) through the sheath into the dilated vein (varicocele) draining the testicle. X-ray dye (contrast) will be injected through the catheter to define the anatomy of your veins. You may experience a warm feeling in the abdomen, pelvis and or groin – this is normal.
The veins are blocked using small metal coils (springs) At the end of the procedure the catheter and vascular sheath are removed and pressure is applied to the groin (or neck) for 5 minutes to prevent bleeding.
Every patient is different, however, expect to be in the radiology department for up to 1 hour.
After the procedure
You will be transferred to your ward where your pulse, blood pressure, oxygen levels and the entry site in the groin will be checked by our team at regular intervals. You should expect to be in bed for up to 6 hours until you have recovered.
You should be able to drive in 24 hours, return to work within 72 hours and exercise in 3 to 5 days.
Dr Zertalis will organise a follow-up appointment 1 month after the procedure and an US scan in 3-6 months to evaluate the outcome of the procedure.
