Comparison of transbrachial and transfemoral venous access in varicocele embolization: impact on radiation dose and technical success

Abstract Objectives This study evaluates the advantages of superficial venous transbrachial access compared to conventional transfemoral access in varicocele embolization, focusing on technical success and radiation dose reduction. Materials and methods A retrospective analysis was conducted on 241 patients in whom 247 varicocele embolization procedures were performed via transbrachial ( n = 145, 58.7%) or transfemoral ( n = 102, 41.3%) venous access. Procedural parameters, including radiation exposure (fluoroscopy time and dose-area product), technical success, material consumption, and complications, were compared using propensity score matching (1:1). Results Forty-one matched pairs of transbrachial and transfemoral accesses were analyzed. Technical success rates were similar between transbrachial (95.1%) and transfemoral access (82.9%, p = 0.15). Transfemoral access was associated with a significantly higher dose-area product (ratio of geometric means 1.68, 95% CI: 1.06–2.66, p = 0.032), corresponding to a 68% increase. Additionally, the transfemoral approach was associated with a significantly longer fluoroscopy time (+ 608 s, 95% CI: 28- 1188 s, p = 0.043) and procedural time (1:15 [0:59–1:33] vs 1:39 [1:00–2:05] h; p = 0.04). There were no significant differences in overall and access-site-related complications. Conclusion The transbrachial approach may reduce radiation exposure and potentially improve the technical success rate in varicocele embolization, particularly in bilateral embolization, while maintaining procedural safety. Given that this procedure is typically performed in young, otherwise healthy men, a transbrachial access should be considered as a beneficial alternative. Key Points Question Radiation dose reduction is essential in varicocele embolization performed in young, healthy patients, but the impact of venous access site on radiation exposure and procedural performance remains unclear . Findings In varicocele embolization, transbrachial venous access resulted in lower radiation dose, procedural time, and material consumption, while potentially offering a slightly higher technical success rate . Clinical relevance Transbrachial venous access should be considered an appealing alternative to the transfemoral approach in varicocele embolization, as it is associated with reduced radiation exposure in a predominantly young and otherwise healthy patient population .