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 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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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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