What are the risks and potential complications of varicocele embolisation?

Risks of Varicocele Embolization

Varicocele embolization is a safe minimally invasive procedure with technical success rates of approximately 90-98%, but carries specific risks including coil migration (<2%), vascular perforation, thrombosis, and non-target embolization, with minor complications occurring in approximately 10% of cases. 1, 2, 3

Major Complications (Rare but Serious)

Embolic Material Migration

• Coil migration occurs in <2% of cases and represents the most feared major complication 4
• Sclerosant material can migrate beyond intended targets, with documented cases of migration to the left renal vein causing non-occlusive thrombus requiring anticoagulation 5
• Non-target vessel embolization has been reported, though rates are very low when proper technique is employed 4, 1

Vascular Complications

• Vascular perforation is a recognized serious complication requiring interventional radiologic expertise to manage 1
• Extravasation occurs in approximately 4.7% of cases but is typically self-limiting and does not require intervention 3
• Thrombosis of the pampiniform plexus can occur, though this is uncommon 1

Venous Thrombotic Events

• Renal vein thrombosis has been documented when sclerosant migrates proximally, requiring 3 months of anticoagulation therapy 5
• Portal and splenic vein thrombosis are extremely rare complications 4

Minor Complications (More Common)

Post-Procedural Pain

• Transient post-embolization pain is common, occurring in up to 14.8% of patients 4
• Temporary scrotal pain reported in 3.5% of cases 3
• Colic-like pain can occur with sclerotherapy but typically resolves spontaneously within 5 minutes 4
• Pain is usually self-limited or managed with analgesics and anti-inflammatory medications 4

Access Site Issues

• Puncture site complications occur but rarely require transfusion or affect neural structures 4
• These are classified as minor when they require no specific treatment beyond observation 4

Other Minor Complications

• Localized pain and swelling at the access site 4
• Fever can occur as a post-procedural response 4
• Overall minor complication rate is approximately 10.45% 2

Technical Failure Risks

• Technical success is not achieved in approximately 2-12% of attempts 1, 3
• Failure most commonly occurs when access to the lower spermatic vein is not possible due to vessel tortuosity or complex anatomy 6
• Unsuitable anatomy for embolization is encountered in some cases, preventing procedure completion 3
• Recurrence rates range from 1.6-10%, with higher rates associated with more complex local anatomy (Type 3 and Type 4) 3

Contrast-Related Risks

• Contrast-induced nephropathy is a recognized potential complication 4
• This risk should be considered in patients with pre-existing renal impairment 4

Radiation Exposure

• Mean fluoroscopy time is 20.3 ± 14.9 minutes with dose area product of 63.2 ± 50.5 Gy·cm² 2
• No significant difference in radiation exposure between neck versus groin access approaches 3

Important Clinical Context

The procedure demands interventional radiologic expertise to minimize serious complications 1. Despite these risks, varicocele embolization remains highly effective with clinical success rates of 70% for scrotal pain and 87% resolution of orchialgia in appropriately selected patients 7, 2. The absence of hydrocele formation risk (a common surgical complication) represents a significant advantage of the embolization approach 6.