Abstract:

This article deals with the role of arterio-venous conflicts in case of varicocele development in children. As varicocele is a widespread disease, it is important to investigate the etiology of hemodynamic disturbances in renotesticular (RTT) and ileotesticular (ITT) fields in patients with varicocele. The number of procedures registered in Russian State Pediatric Hospital (Moscow) is more than 1600 including primary and recurrent cases. Pathophisiology of the disease is not quite clear, but hemodynamic changes in RTT and ITT were thoroughly investigated. Left renal vein compression between upper mesenterial vein and aorta causes renal venous hypertension in 24% of cases. In most cases etiology of varicocele was primary valve insufficiency. Ileofemoral vericocele is rare and occurs as a result of common iliac vein flow disturbance. Endovascular procedures should be performed only after diagnostic hemodynamic study, and should not be used in pediatric practice. 

References 

1.      May R., Thurner J. The cause of the predominately sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957; 8: 419-427.

2.      De Schepper A. Nutcracker phenomenon of the renal vein causing left renal vein pathology.J. Belg. Rad. 1972; 55: 507-511.

3.      Trambert J.J. et al. Pericaliceal varices due to the nutcracker phenomenon. AJR. 1990; 154:305-306.

4.      Scholbach T. From the nutcracker-phenome non of the left renal vein to the midline congestion syndrome as a cause of migraine, headache, back and abdominal pain and functional   disorders   of   pelvic   organs.   Medical. Hypotheses. 2007; 68: 1318-1327.

5.      Лопаткин Н.А., Морозов А.В., Житникова Л.Н. Стеноз почечной вены. М.: Медицина.1984.

6.      Страхов С.Н. Варикозное расширение вен гроздевидного   сплетения   и   семенного канатика (варикоцеле). М. 2001.

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

8.      Coolsaet l.E. The varicocele syndrome: Venography determining tin' optimal level for surgical management.J. Urol. 1980; 124: 833-839.

9.      Ерохин А.П. Варикоцеле у детей (клинико-экспериментальное исследование). Дис. д-ра мед. наук. М. 1979.

10.    Neglén А. et al. Stenting of the venous outflow in chronic venous disease. Long-term stent-related outcome, clinical and hemodynamic result.J. Vasc. Surg. 2007; 46: 979-990.

11.    Гарбузов Р.В. Ретроградная эндоваскулярная окклюзия при варикоцеле у детей и подростков. Дис. канд. мед. наук. М. 2007

Abstract:

Aim. Was to demonstrate our experience of using the stent-assistant technology for treatment of thromboembolic complication during endovascular procedures in extra- and intracranial arteries.

Materials and methods. Five patients with thromboembolic complication were successfully treated using stent-assistant technology In one case thromboembolic complication appeared during stenting of ICA, another - during performing of diagnostic cerebral angiography In 3 cases thromboembolic complications appeared during endovascular occlusion of intracranial artery. In four cases we used stent Solitaire (Covidien) in one case - Enterprise (Codman).

Results. In all cases we achieved full restoration of blood flow in intracranial vessels. Three patients were discharged without any neurological deficit. Two patients were discharged with minimal neurological deficit (mRS 1).

Conclusion. Stent-assistant technology can be successfully used in treatment of thromboembolic complications during endovascular procedures in extra- and intracranial arteries.

References

1.     Connors J., Sacks D., Furlan A., et al. Training, competency, and credentialing standards for diagnostic сervicocerebral angiography, carotid stenting, and cerebrovascular intervention: a joint statement from the American academy of neurology, American association of neurological surgeons1, American society of interventional and therapeutic radiology, American society of neuroradiology, congress of neurological surgeons, AANS/CNS cerebrovascular section, and society of interventional radiology. Radiology. 2005; 234: 26-34.

2.     Qureshi I., Luft R., Sharna M., et al. Prevention and treatment of tromboembolic and ischemic complications associated with endovascular procedures: Part I. Pathophysiological and pharmacological features. Neurosurgery. 2000; 46: 1344-1359.

3.     Bracard S., Abdel-Kerim A., Thuillier L., et all. Endovascular coil occlusion of 152 middle cerebral artery aneurysms: initial and midterm angiographic and clinical results. J. Neurosurg. 2010; 112: 703-708.

4.     Fujii Y., Takeuchi S., Sasaki O., et al. Hemostasisin spontaneous subarachnoid hemorrhage. Neurosurgery. 1995; 37: 226-234.

5.     Blackham A., Meyers P., Abruzzo T., et al. Endovascular therapy of acute ischemic stroke: report of the standards of practice committee of the society of neurointerventional. J. NeturoIntevent. Surg. 2012; 4: 87-93.

6.     Costalat V., Machi P., Lobotesis K., et al. Rescue, combined, and stand-alone thrombectomy in the management of large vessel occlusion stroke using the solitaire device: a prospective 50-patient single-center study: timing, safety, and efficacy. Stroke. 2011; 42:1929-1935.

7.     Gonzalez F., Jabbour P., TJoumakaris S., et all. Temporary endovascular bypass: rescue technique during mechanical thrombolysis. Neurosurgery. 2012; 70: 245-252.

8.     Saver J., Jahan R., Levy E.I., et all. Primary results of the Solitaire With Intention for Thrombectomy (SWIFT) multicenter, randomised trial. Presented at the international stroke ranference 2012.