Transfemoral versus Transjugular Varicocele Embolization: Does It Affect the Technical Success Rate and Radiation Exposure?

PURPOSE: To evaluate whether transjugular venous access, which provides a more direct anatomical trajectory to the internal spermatic vein, decreases radiation exposure without reducing technical success compared with the transfemoral approach for varicocele embolization.

MATERIALS AND

METHODS

This single-center retrospective cohort study included all patients who underwent percutaneous varicocele embolization for infertility between August 2019 and November 2025. Procedures were performed exclusively via transfemoral access until August 2024 and via transjugular access thereafter. Radiation exposure was assessed using dose-area product (DAP) and fluoroscopy time. Technical success was defined as complete embolization of all refluxing internal spermatic veins. Group comparisons were performed using nonparametric tests. Multivariable regression analyses were used to identify factors associated with radiation exposure and technical success.

RESULTS

A total of 144 patients were included: 102 underwent transfemoral, and 42 underwent transjugular embolization. Baseline clinical characteristics were comparable between groups. Median DAP was significantly lower in the transjugular group than in the transfemoral group (6,280 mGy·cm2 [interquartile range {IQR}, 4,340-9,830 mGy·cm2] vs 13,000 mGy·cm2 [IQR, 8,510-27,100 mGy·cm2], P < .001), whereas fluoroscopy time did not differ significantly (8.52 minutes vs 8.87 minutes, P = .866). Technical success rates were high in both groups and did not differ significantly (transjugular, 92.9%, vs transfemoral, 83.3%; P = .186). In multivariable analysis, transjugular access was an independent predictor of lower radiation exposure, whereas prior varicocele ligation was a negative predictor of technical success. No major complications occurred.

CONCLUSIONS

Transjugular venous access for varicocele embolization is associated with significantly lower radiation exposure without compromising technical success.