Abstract:

The article presents analysis of 1500 cases of varicocele endovascular occlusion (EO) in children and adolescents, giving the exhaustive account of varicocele diagnostics and treatment. Standardization of the endovascular procedure was performed, and algorithm proposed for choosing the occlusion technique and embolization agent depending on the lesion anatomy.

The authors specify 5 anatomical varieties of left testicular vein (LTV), each having some particularities in occlusion procedure. For the first time in pediatric practice the Foam-form was used for LTV occlusion against the background of prominent veno-venous reflux, which considered to be one EO contraindications. The causes were specified for false and true varicocele recurrence: the former is shown to occur due to technical imperfections, and the causes of the latter can be LTV lumen recanalization or formation of the bridging collaterals.

EO of LTV is proved to be the effective for recurrent varicocele after conventional surgery in children and adolescents.   

Reference 

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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. 

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