Abstract:

Aim: was to evaluate diagnostic results in patients with left-sided varicocele through the use of occlusive balloon catheter during the diagnostic phlebotesticulography.

Materials and methods: traditional venographic examination was performed in 29 patients with newly diagnosed varicocele. Basing on obtained data a new diagnostic venography approach was worked out, according that - 10 patients with left-sided varicocele underwent venography examination.

Results: Using the new diagnostic venography approach in 10 patients with left-sided varicocele was received complete information about the anatomy of the left internal spermatic vein, its collaterals, as well as hemodynamic changes of external iliac vein and spermatic vein it became possible to determine the type of hemodynamic disturbances of outflow of blood from the pampiniform plexus.

Conclusion. The developed method of diagnostic venography provides a complete picture of causes of changes in veins involved in the drainage of the pampiniform venous plexus. Obtained data of hemodynamic and angioarchitectonics changes of venous basins draining pampiniform plexus, contribute to the choice of the optimal method of surgical correction of venous blood flow spermatic veins.

Angiography is the «gold standard» in the diagnosis of varicocele. The developed method of diagnostic venography improves the efficiency of the method of diagnostic venography, which improves the results of treatment of varicocele.

Abstract:

Aim. Was to estimate the role of transcutaneous interventions under the supervision of radiodiagnostics in the maintenance of all mini-nvasive kinds of operation stages of surgical treatment in patients with pancreatic and duodenal zone tumors

Materials and methods. For the period from January 2007 till march 2010, 21 patients, aged 49-75 (10 men, 11 women) - were under aparoscopic pancreaticoduodenectomy (LPDE)

Results. The use bile ducts drainage systems before LPDE in 95% cases leads to small hemorrhage (less than 1 liter). The presence of cholangiostomy also leads to early diagnostics of biliodigistive anastamosis (BDA) stenosis, and makes bile peritonitis – impossible.

Conclusion. Usage of non-vascular methods of interventional radiology allows to make effective and less traumatic biliar decompression in patients with biliopancreatic and duodenal zone tumors as a stage of LPDE preparations. The presence of decompression cholangiostomy prevents further BDA inconsistency, and makes pacreaticojejunoanastamosis healing faster in case of its' decompression.

References 

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2.    Савельев В.С., Кошкин В.М. Критическая ишемия нижних конечностей. М.: Медицина. 1997; 160.

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5.    Stokes K.R. et al. Five-year results of iliac end femoropopliteal angioplasty in diabetic patients. Radiology. 1990; 174: 977-982.

6.    Минкин С., Рабкин Д. Экспериментально-морфологическое исследование динамики «вживления» рентгеноэндоваскулярных протезов в сосудистую стенку. Материалы 8-го симпозиума по рентгеноэндоваскуляр-ной хирургии. Москва - Ереван. 1987; 12.

7.    Maas D. et al. Radiological follow-ap of transluminalli inserted vascular endoprothes-es. An experimental study using expanding spirals. Radiology. 1984; 152: 659-663.

8.    Blum U. et al. Percutaneous recanalization of iliac occlusions. Resultsof a prosrective study. Radiology. 1993; 189: 536-540.

9.    Henry M. et al. Stenting of femoral and popliteal arteries. Tenth international book of peripheral vascular intervention. 1995; 199: 368-369.

10.  Henry M. et al. Palmaz stent placement in iliac and femoropopliteal arteries. Primary and secondary patency in 310 patients 2-4 year follow-up. Radiology.  1995;  197: 167-174.

11.  Коков Л.С., Покровский А.В., Балан А.Н. и др. Отдаленные результаты клинического применения отечественного нитинолово-го стента для лечения стенозирующих поражений артерий. Ангиология и сосудистая хирургия. 2002; 8 (1): 41-46.

12.  Scheinert D. et al. Stent supported recanaliza-tion of chronic iliac artery occlusions. Tenth international book of peripheral vascular intervention. Edited by M. Hanry. M. Fmor.Paris. 1999; 303-313.

13.  Zeller T. Long-term results after recanalisation of thrombotic occlusions of native and stented arteries using a rotationals thrombectomy device. The Paris Course on Revascularization. Paris. 2002; 435-441.

14.  White C.J. Peripheral аtherectomi with the рullback аtherectomy сatheter. Procedural safety and efficacy in a multicenter trail. J. of Endovascular. Surgery. 1998; 5: 9-17.

15.  Yoffe B. et al. Preliminary experience with the Xtrak debulking device the treatment of peripheral occlusions. J. Endovasc. Ther. 2002; 9: 234-240.

16.  Zeller T. et al. Midterm results after atherectomy-assisted angioplasty of below-knee arteries with use of the silverhawk device. J. Intervent. Radiol. 2004; 15: 1391-1397.

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Abstract:

Purpose. Оf the study was to prevent complications and improve the results of left-sided varicocele treatment.

Material and methods. Severe complications of open surgery (Ivanisevich technique) and endovascular procedures (left internal testicular vein embolization with metal coils) were analyzed.

Results. In all these cases we performed control angiographywas perfomed and the degree of anatomical and functional disturbances was assessed. Ways of complication prevention and countermeasures were offered.

Conclusions. Visualization of testicular venous bed should be made before any surgical or endovascular intervention on left varicocele. A surgeon should be aware of all possible complications. If some complication occurs, urgent visualization of the vascular bed and tissues ought to be performed, angiography being the golden standard. Complications if diagnosed should be eliminated as soon as possible by specialists. 

References 

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2.      Dubin   L., Amelan R.D. Varicocelectomi as   Therapy   in   Male   infertility Stady   of 504 cases.    J.     Urol.    1975;     133 (15):604-641.

3.      Hommonai  Z.T.  et  al.  Tecticula function after herniotomy. Herniotomy and fertility. Andrologia. 1980; 11: 115-120.

4.      Рыжков В.К., Карев А.В., Таразов П.Г. и др. Комбинированные методы внутрисосудистых вмешательств при лечении варикоцеле. Урология и нефрология. 1999; 3: 18-22.

5.      Артюхин А.А. Фундаментальные основы сосудистой андрологии. М.: «Академия».  2008; 222.

6.      Кадыров З.А. Лапароскопическая урологическая хирургия. Урология и нефрология.  1997; 1: 40-44.

7.      Ким В.В., Казимиров В.Г. Анатомо-функциональное обоснование оперативного лечения варикоцеле. М.: ИД «Медпрактика-М». 2008; 112.

8.      Bach D. et al. Spaterqebnise nach Sclerotherapie der Varicocele. Uroloqe. 1984; 23 (6): 338-341.

Abstract:

Aim: was to estimate possibilities of the clinically developed method of diagnostic phlebography among patients with newly diagnosed and recurrent varicocele.

Materials and methods: phlebography was performed on 44 patients with left-sided varicocele . 24 of them have newly diagnosed varicocele and other 20 patients have recurrent varicocele. The age of patients varies from 12 to 48 years. During phlebographic studies the clinically developed method of diagnostic phlebography was applied to all patients. This method is based on the application of obturating balloon catheter installed in left internal spermatic vein.

Results: as a result of the study, structural features of left internal spermatic vein were revealed among patients with newly diagnosed and recurrent varicocele. Also, angioarchitecture variants of external spermatic vein and its hemodynamic features were defined. The pelvic venous basin angiographic characters of hemodynamic disorders were marked.

Conclusions: the phlebotesticulography through left internal spermatic vein balloon obturation gives the opportunity to get full information about left testis' venous circulation architecture and hemodynamics. The obtained information allows to choose both traditional methods of surgical treatment and inter-venous anastomosis microsurgery.

References

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3.     Strahov S.N. Varikoznoe rasshirenie ven grozdevidnogo spletenija i semennogo kanatika (varikocele) [Varicose veins of uviform plexus and spermatic cord (varicocele)] M. 200; 234S [In Russ].

4.     Kim V.V., Kazimirov V.G. Anatomo-funkcional'noe obosnovanie operativnogo lechenija varikocele[Anatomic-functional justifications of operative treatment of varicocele]. M: Medpraktika. 2008; 112S [In Russ].

5.     Kulikov Ju.S. O patogeneze varikocele [About pathogenesis of varicocele.]. Urologija i nefrologija. 1970; 6: 39-43[In Russ].

6.     Stepanov V.N., Kadyrov Z.A. Diagnostika i lechenie varikocele [Diagnostics

and treatment of varicocele]. M: 2001; 3-206 [In Russ].

7.     Garbuzov R.V., Poljaev Ju.A., Petrushin A.V. Arteriovenoznye konflikty i varikocele u podrostkovn [Arteriovenous conflicts and varicocele in teen]. Diagnosticheskaja i intervencionnaja radiologija. 2010; 4 (3) 31-36 [In Russ].

8.     Coolsaet B.I. The varicocele sindrom: venography determining the optimal level surgical management J. Urol. 1980; 124: 833-834.

9.     Bomalaski M.D., Mills J., Argueso L.R., et al. Iliac vien compression syndrome: an unusual case of varicocele. J. Vasc. Surg. 1993; 18(6): 1064-1068.

10.   Osipov N.G., Obel'chak I.S. Sposob diagnosticheskoj flebografii pri varikocele. Patent na izobretenie №24890 12.08.2011 [Method of diagnostic phlebography in patients with varicocele. Patent on invention №24890 12.08.2011] [In Russ]. 

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.  

References

1.    Strahov S.N. Varikoznoe rasshirenie ven grozdevidnogo spleteniya i semennogo kanatika (varikotsele) [Varicose of internal spermatic vein and spermatic cord (varicocele)]. M. 2001; 235S [In Russ].

2.    Stepanov V.N., Kadyirov Z.A. Diagnostika i lechenie varikotsele [Diagnostics and treatment of varicocele]. M., 2001; 200S[In Russ].

3.    Lopatkin N.A., Morozov A.V., Jitnikova L.N. Stenoz pochechnoy venyi [Stenosis of renal veins]. M.: Meditsina. 1984; 102 S [In Russ].

4.     Coolsaet B.L. The varicocele sindrom: venographi determining the optimal ievel for surgical management. J. Urol. 1980; 124: 833-834.

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8.     Kim et al. Hemodynamic Investigation of the Left Renal Vein in Pediatric Varicocele. Doppler US, Venography and Pressure Measurements. Radiology. 2006; 241.

9.     Garbuzov R.V., Polyaev YU.A., Petrushin A.V. Arteriovenoznyiy konflikt i varikotsele u podrostkov [Arteriovenous conflict and varicocele in teenagers] Diagnosticheskaya i iterventsionnaya radiologiya 2010; 4(3): 31-36 [In Russ].

10.   Kogan M.I., Afoko A., Tampuori D., Asanti-Asamani A., Pipchenko O.I. Varikotsele: protivorechiya problemyi [Varicocele: conflict issues.]. Urologiya 2009; 6: 67-72 [In Russ].

11.   Kadyirov Z.A. Varikotsele [Varicocele]. M., 2007; 269S [In Russ].

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13.   Reynberg S.A. Rentgenodiagnostika zabolevaniy kostey i sustavov [X-ray diagnostics in diseases of bones and joints]. M., 1964; t. II: 188-189 [In Russ].

14.   Korolyuk I.P. Rentgenanatomicheskiy atlas skeletal [Atlas of X-ray anatomy of skeleton.]. M., 1994; 192S [In Russ].