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 Abstract:

Aim: was to estimate changes in architectonic and hemodynamics of left common iliac vein (lCIV), caused by its crossing with right common iliac artery (rCIA), in patients with varicocele according to data of computed tomography angiography (CTA) and contrast venography.

Materials and methods: we analyzed results of CTA and contrast venography in the area of arte-riovenous crossing: 37 patients with newly diagnosed and 45 with recurrent varicocele. Analysis of topical changes was made on data of axial tomography, multiplanar and 3D reconstructions. Hemodynamic changes in lCIV, were determined by dynamic venogram and results of mesurement of pressure gradient between lCIV and vena cava inferior (VCI).

Results: it was found that CTA is the most informative for visualizing of lCIV narrowing caused by its compression by rCIA. This is due to the possibility of obtaining a same contrasting imaging of vessels involved in arteriovenous «conflict». Multiple view scanning reconstruction revealed a correlation between size of the lumbosacral angle and the degree of compression of lCIV caused by arteriovenous conflict. CT angiography with the use of utility model, allowed to change the state of the arteriovenous crossing, showed compression instability Dynamic contrast venography showed angiographic features typical for lCIV compression, and also visualized venous collaterals that compensate blood-flow disorders. Conducting direct measurement of venous pressure gradient in compression area allowed us to estimate the degree of hemodynamic changes in lCIV and explore the mechanism of compression generated by pulsating blood flow of rCIA.

Conclusions: severity of compression of lCIV at arteriovenous «conflict» is affected by constitutionally-static angle between L5-S1 vertebral bodies. Compression degree of lCIV is not constant and may vary depending on the patient's body position. Compression of lCIV promotes collateral blood flow through veins of sacral and external lumbar drainage. The more expressed compression of lCIV the more developed collateral blood flow in both drainage systems. Developed collaterals compensate hypertension caused by compression of lCIV Estimation of venous blood flow disorders, in case of varicocele, and choice of method of surgical treatment should be based on data from X-ray contrast studies and results of tensometry conducted at the area of arteriovenous «conflict» of lCIV. 

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