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 

1.     Ерохин АП. Варикоцеле у детей (клинико-эксперементальное исследование). Дис.д-ра мед. наук. М. 1979.

2.     Тарусин Д.И. Факторы риска репродуктивных расстройств у мальчиков и юношей-подростков. Автореф. д-ра мед. наук. М. 2005.

3.     Кондаков В.Т., Пыков М.И., Годлевский Д.Н. Андрологические аспекты хирургического лечения варикоцеле у подростков. Медицина и здравоохранение. 2004;     10.9: 35-39.

4.     Годлевский Д.Н. Сперматогенная функцияяичек и органный кровоток при варикоцеле у детей и подростков. Автореф. канд. мед. наук. М. 2003.

5.     Корзникова И.И. Эндоваскулярная склеротерапия в лечении варикоцеле у детей.Автореф. канд. мед. наук. М. 1988.      12.

6.     Страхов С.Н. Варикозное расширение венгроздевидного сплетения и семенногоканотика. М. 2001.

7.     Лопаткин Н.А., Морозов А.В., Дзеранов Н.К. Трансфеморальная эндоваскулярная облитерация яичковой вены в лечении варикоцеле. Урол. нефрол. 1983; 6: 1-53.

8.     Tauber R., Johnsen N. Antegrade scrotal sclerotherapy for the treatment of varicocele. Technique and late results. J. Urol. 1994; 51 (2): 386-390.

9.     Palomo A., Bernard C.A. A practical resource in the surgical treatment of the scrotalrgans. Rev. Col. Med. Guatem. 1959; 10: 246-247.

10.   Esposito C, VallaJ.S., Najmaldin A. et al. Incidence and management of hydrocele following varicocele surgery in children. J. Urol. 2004; 171 (3): 1271-1273.

11.   Tessari L., Cavezzi A., Frullini A. Preliminary. Еxperience with a new sclerosing foam in the treatment of varicose veins. Dermatol. Surg. 2001; 27 (1): 58-60.

12.   Mali W.P., Oei H.Y., Arndt J.W. et al. Hemodynamics of the varicocele. II. Correlation among the results of renocaval pressure measurements, varicocele scintigraphy and phlebography. Urol. 1986; 135 (3): 489-493.

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:

Purpose. Was to define the capability of multi-slice computed tomography angiography (MSCT-angiography) in diagnostics of arteriove-nosus conflict in patients with primary and recurrent varicocele.

Materials and methods. 46 patients with left-side varicocele were underwent MSCT-angiography: 36 had firstly diagnosed disease, 10 had recurrent types. Capability of MSCT-angiography in the zone of possible arteriovenosus conflicts was estimated on the base of imaging analysis: axial, multiplanar and 3D-imaging of left renal vein (LRV), a.mesenterica superior (AMS) in aortomesenterical zone, and crossing place of left iliaca communis vein(LICV) and right iliaca communis artery (LICA). We have investigated structure features of left testiculars vein (LTV) in patients with primary and recurrent varicocele.

Results. All the patients during axial imaging analysis we have investigated the crossing place of LRV and LICV with conflict arteries - AMS and LICA. We have revealed featured of LRV, compressed by AMS, on the base of axial and multiplanar imaging changes. Analysis of axial multiplanar and 3D-reconstruction has showed high capability in diagnostics of arteriovenosus conflict on the level LICV Study of multiplanar and CT-imaging in case of LICV valve insufficiency and different types of anatomy is possible

Conclusions. Taking into consideration diagnostic capability, technical simplicity and high sensitivity of MSCT-angiography in diagnostics of arteriovenosus conflicts in varicocele, this methodic must be included in algorithm of patients examination in case of primary and recurrent varicocele. MSCT-angiography in definition of haemodynamic types of disorders can promote the right choice of surgical correction.

References 

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

2.    Степанов В.Н., Кадыров З.А. Диагностика и лечение варикоцеле. М. 2001; 200.

3.    Бавильский В.Ф., Суворов А.В., Иванов А.В. и др. Выбор метода оперативного лечения варикоцеле.  Урология. 2003; 6: 40-43.

4.    Гарбузов Р.В., Поляев Ю.А., Петрушин А.В. Артериовенозный конфликт и варикоцеле у подростков. Диагностическая и итервенционная радиология. 2010; 4 (3): 31-36.

5.    Мазо Е.Б., Тирси К.А., Андранович С.В., Дмитриев Д.Г. Ультразвуковой тест и скротальная допплер-эхография в предоперационной диагностике гемо-динамического типа варикоцеле. Урология и нефрология. 1999; 3: 22-26.

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

7.    Коган М.И., Афоко А., Тампуори Д., Асанти-Асамани А., Пипченко О.И. Варикоцеле: противоречия проблемы. Урология. 2009; 6: 67-72.

8.    Кадыров З.А. Варикоцеле. М.: Медицина. 2006.

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 

1.      Ivanissevich O., Gregorini H. Una neuva operation   para curar el varicocele. S.Semana med. (Buenos Aires).   1918;   20:575-576.

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:

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 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

1.     Artjuhin A.A. Fundamental'nye osnovy sosudistoj andrologii [Fundamental basics of vascular andrology]. M.: Akademija. 2008; 222 S [In Russ].

2.     Kondakov V.T., Pykov M.I. Varikocele[Varicocele]. M. 2000; 91S [In Russ].

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.

5.     May R., Thurner J. The cause of predominantly sinistral occurrence of thrombosis of the pelvic veins. Minerva Cardioangiol. 1957; 3: 346-9.

6.     Cockett F.B. Thomas M.L. Negus D. Iliac vein compression: its relation to iliofemoral thrombosis and the postthromdotic syndrome. BMJ. 1967; 2: 14-19.

7.     Mazo E.B., Tirsi K.A., Andranovich S.V., Dmitriev D.G. Ultrazvukovoy test i skrotalnaya dopler-ehografiya v predoperatsionnoy diagnostike gemodinamicheskogo tipa varikotsele [Ultrasound test and doppler-echography of scrotum in preoperative diagnostics of hemodynamically type of varicocele]. Urologiya i nefrologiya 1999; 3: 22-26 [In Russ].

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].