Percutaneous transluminal treatment of varicoceles: where to occlude the internal spermatic vein

Percutaneous transluminal sclerotherapy is an accepted treatment for varicoceles. It is administered by applying a liquid sclerosing agent to the internal spermatic vein. However, the optimal site for the placement of the occlusive material has not been evaluated previously. Therefore, the success rate of sclerotherapy was determined in two groups of patients. In the first group (34 patients), the liquid agent was applied in the cranial part of the internal spermatic vein; in the second group (113 patients), the agent was applied in the caudal part of the vessel at the level of the inguinal ring. The success rate determined 3 months after therapy by telethermography was significantly higher after treatment in the caudal part (82%) than in the cranial part (68%) of the vessel. Sclerotherapy at the level of the inguinal ring appears to be superior to therapy in the cranial part of the internal spermatic vein.     

Selective sclerotherapy of the internal spermatic vein in patients with varicoceles

Percutaneous occlusion therapy of insufficient internal spermatic veins was performed successfully as an outpatient procedure in 155 patients with varicoceles. The administration of the sclerosing agent (Varicocid) through a catheter selectively introduced into the spermatic vein caused therapeutic occlusion. Follow-up studies, both clinical and phlebographic, confirmed the effectiveness of the treatment.     

双侧精索静脉曲张行左侧精索静脉腹壁下静脉搭桥术的疗效观察

目的探索双侧精索静脉曲张仅行左侧精索静脉腹壁下静脉搭桥术的疗效。方法 45例双侧精索静脉曲张患者,在腰硬联合麻醉下行左侧精索静脉腹壁下静脉搭桥术,右侧不做治疗。结果 45例患者中右侧精索静脉曲张轻度33例,中度12例,术后3～12个月彩色多普勒超声复查,双侧精索静脉血流反流信号均消失,右侧精索静脉40例转为正常,5例转为轻度;左侧33例正常,12例转为轻度。结论双侧精索静脉曲张右侧不做治疗,行左侧精索静脉腹壁下静脉搭桥术是安全、有效的。     

Percutaneous venography and occlusion in the management of spermatic varicoceles

Spermatic venography was performed in 140 patients; the main indications were subfertility and abnormal spermatogenesis. Of these 140 patients, 113 had positive examinations, with 33 of them having bilateral varicoceles. Of 146 total varicoceles demonstrated, 42 were found on the right side; the advantage of using the jugular vein approach in both the diagnosis and percutaneous treatment of these cases is stressed. Of the 146 varicoceles, 128 were successfully occluded using spring coils. Because of the frequency of bilateral subclinical varicoceles, spermatic venography and percutaneous embolization is recommended in all men with subfertility and oligoteratoasthenospermia.     

急性左下肢深静脉血栓形成伴髂静脉受压综合征一站式介入治疗临床效果和流程分析

目的 探讨一站式经皮机械清除血栓(PMT)和髂静脉成形术治疗急性左下肢深静脉血栓形成(DVT)伴髂静脉受压综合征(IVCS)安全性、有效性及流程.方法 回顾性分析2016年1月至2018年12月在广东省中医院接受一站式PMT、经皮腔内血管成形术(PTA)和髂静脉支架植入术治疗的41例急性左下肢DVT伴IVCS患者临床资...     

Anatomic variations of the cerebral arteries and their embryology: a pictorial review

In the embryonic period, several developmental anomalies of the cerebral arteries occur. The knowledge of these anatomic variations of the cerebral artery is important to avoid the unnecessary surgery and to undergo surgery or interventional radiology with safety. We reviewed 3000 MR angiographies and 700 cerebral angiographies of the previous 5 years to assess cerebral arterial system, and to illustrate the embryological development, imaging findings, occurrence, and clinical significance of the anatomic variation of the cerebral arteries. The normal development and variations of the cerebral arteries are depicted. Knowledge of the anatomic variations is important since it can influence surgical and interventional procedure.     

Initial primary endovascular treatment in the management of ruptured intracranial aneurysms: a prospective consecutive series

Introduction From January 1998 to December 2002, endovascular treatment (EVT) was used as first intention in all patients with ruptured aneurysms. The objective of this study was to analyze the results of this therapeutic strategy.Methods Among 401 patients admitted with a subarachnoid hemorrhage (SAH), 73 (18%) had a nonaneurysmal perimesencephalic SAH, 28 were not explored by angiography due to very poor clinical status, and 28 with aneurysmal SAH were not treated due to poor clinical status. Thus, of the 300 patients with a proven aneurysmal SAH, 272 (83%) were treated. EVT was attempted in 230 patients and was successful in 222 (82%), and clipping was performed in 50 (18%).Results Finally, EVT was successful in 234 aneurysms (96.7%) in 222 patients out of 242 aneurysms in 230 patients (some of the patients were treated for more than one aneurysm in the same procedure). EVT-related morbidity occurred in ten patients (4.5%) and mortality in eight (3.6%). Rate of dependency or death (modified Rankin scale 3–5) was 24.5% at 26 months. Initially, complete aneurysm occlusion was obtained in 81%, a dog ear in 3.4%, a neck remnant in 8% and incomplete occlusion in 8.1% of the patients. At follow-up (mean 26 months), the occlusion rate remained stable at 75%.Conclusion This consecutive prospective series shows that EVT can be performed routinely as first-intention treatment in most aneurysmal SAH. Using this therapeutic strategy, EVT was performed in 82% of patients with long-term clinical results similar to those of the ISAT study.     

Anatomic variations of the shape of the menisci: a neonatal cadaver study

Meniscal injuries in children and adolescents are being seen with increased frequency. The menisci are two crescentic lamellae whose functions are to deepen the articular surfaces of the tibial plateu for reception of the condyles of the femur. In our study, our aim is to determine the variations of the shapes and attachments of the menisci in newborns. This study was performed on 11 neonatal cadavers, 22 knee joints that were obtained from the anatomy laboratory. The variations of the shape of the menisci were noted. We found that 77% of the lateral menisci were discoid. This percent is higher than the previously reported percents of the lateral discoid menisci. The different shapes of the menisci were determined as horse shoe, sickle, sided U, sided V and C shaped. We did not determine any discoid medial menisci. We believe that our study will provide support to the neonatal anatomy of the knee, concerning with the surgical procedures and arthroscopy of the knee joint.This study was presented at the 6th international symposium of clinical anatomy, Varna, Bulgaria, 8–10 October 2004     

Evaluation of the left renal vein variations and inferior vena cava variations by means of helical computed tomography

PurposeTo evaluate the percentages of the left renal vein (LRV) variations and inferior vena cava (IVC) variations as well as the effect of gender on their frequencies.Materials and MethodsContrast-enhanced abdominal helical computed tomography (CT) examinations of 1204 patients were retrospectively evaluated.ResultsThe correspondent percentages of the total LRV variations, retroaortic left renal vein (RLRV), and circumaortic LRV were 5.2%, 3.1%, and 2.1%, respectively. A statistically significant correlation was found between RLRV variation and gender (P= .036).ConclusionsHelical CT is an efficient, fast, easily applicable, and reliable imaging modality in demonstration of LRV variations and IVC variations.     

Iliac vein compression syndrome: outcome of endovascular treatment with long-term follow-up

Objective

To retrospectively evaluate technical success and long-term outcome of endovascular treatment in patients with iliofemoral deep vein thrombosis (DVT) due to iliac vein compression syndrome (IVCS).

Materials and methods

Between March 2003 and September 2006, 36 consecutive patients (26 women [72%], 10 men, mean age 50 ± 18 years) with acute or chronic iliofemoral deep vein thrombosis due to iliac vein compression syndrome were evaluated for outcome of endovascular treatment. Stent patency was estimated by using the Kaplan–Meier method.

Results

Technical success was achieved in 34 of 36 patients (94%). Six patients with acute or subacute thrombosis had chronic occlusion of the left common iliac vein. Rethrombosis of the stents was observed in four patients. Primary and secondary patency rates were 85 and 94% at 1 year, and 80 and 82% at 4 years. Resolution of symptoms was achieved in 17 of 20 patients (85%) with acute and subacute DVT, and 4 of 16 patients (25%) with chronic DVT. Major complication was seen in one patient (3%).

Conclusion

Intimal changes in the left common iliac vein are mostly chronic in nature even in patients with acute DVT secondary to IVCS. Endovascular treatment with stent placement has a high technical success rate and good long-term patency in the treatment of acute and chronic DVT due to IVCS. Symptomatic improvement seems to be better in patients with acute than chronic DVT due to IVCS.     

Association of left renal vein variations and pelvic varices in abdominal MDCT

The aim of this study was to determine whether left renal vein (LRV) variation is associated with pelvic varices and left ovarian vein (LOV) reflux. Routine abdominal multidetector-row computed tomography scans of 324 women without symptoms of pelvic congestion syndrome were analyzed. Presence and type of LRV variants (circumaortic [CLRV] or retroaortic [RLRV]) were recorded. Diameters of the LRV, ovarian veins (OVs), and parauterine veins were measured and a specific LRV diameter ratio was calculated for each patient. Presence and severity of pelvic varices and LOV reflux were noted. Pelvic varices were detected in 59 (18%) of the total of 324 women, in 7 (37%) of the 19 women with RLRVs, in 7 (29%) of the 24 women with CLRVs, and in 45 (16%) of the 281 women with normal LRVs. The frequency of pelvic varices in the women with LRV variation was significantly higher than that in the group with normal LRV anatomy (33 vs. 16%; p=0.009). The frequency of pelvic varices in the women with RLRVs was also significantly higher than that in the group with normal LRV anatomy (p=0.02). LRV diameter ratio was correlated with presence of pelvic varices and presence of LOV reflux (p=0.0001 for both). This study revealed an association between pelvic varices and LRV variations in a population of predominantly multiparous women. The preliminary results of this study were presented as an electronic poster at the ECR (European Congress of Radiology) conference, 3–7 March 2006 in Vienna, Austria.     

Iliac vein compression syndrome: Outcome of endovascular treatment with long-term follow-up

ObjectiveTo retrospectively evaluate technical success and long-term outcome of endovascular treatment in patients with iliofemoral deep vein thrombosis (DVT) due to iliac vein compression syndrome (IVCS).Materials and methodsBetween March 2003 and September 2006, 36 consecutive patients (26 women [72%], 10 men, mean age 50 ± 18 years) with acute or chronic iliofemoral deep vein thrombosis due to iliac vein compression syndrome were evaluated for outcome of endovascular treatment. Stent patency was estimated by using the Kaplan–Meier method.ResultsTechnical success was achieved in 34 of 36 patients (94%). Six patients with acute or subacute thrombosis had chronic occlusion of the left common iliac vein. Rethrombosis of the stents was observed in four patients. Primary and secondary patency rates were 85 and 94% at 1 year, and 80 and 82% at 4 years. Resolution of symptoms was achieved in 17 of 20 patients (85%) with acute and subacute DVT, and 4 of 16 patients (25%) with chronic DVT. Major complication was seen in one patient (3%).ConclusionIntimal changes in the left common iliac vein are mostly chronic in nature even in patients with acute DVT secondary to IVCS. Endovascular treatment with stent placement has a high technical success rate and good long-term patency in the treatment of acute and chronic DVT due to IVCS. Symptomatic improvement seems to be better in patients with acute than chronic DVT due to IVCS.     

Anatomic variations and MRI of the intermalleolar ligament

OBJECTIVE: The purpose of this study was to identify the intermalleolar ligament morphologically and to correlate its shape with MR images. MATERIALS AND METHODS: Seventy-seven ankles were used in this study. After the intermalleolar ligament had been located in the posterior ankle space, its medial and lateral attaching sites were identified, and its length, width, and thickness were measured. MRI was performed on 26 ankles before they were dissected (20 specimens) or serially sectioned (six specimens). The serial sections were taken at a thickness of 2 mm in the sagittal and horizontal directions. RESULTS: The intermalleolar ligament was observed in 81.8% of the specimens and was composed of more than two bundles of fibers in all cases. The medial arising sites of the ligament were diverse (e.g., from the medial malleolus to the floor of the fibrous tunnel of the flexor hallucis longus). The ligament narrowed laterally and attached with the posterior talofibular ligament to the medial fossa of the lateral malleolus. Their morphologic shapes were also diverse, depending on their medial arising sites, the number of the composing fiber bundles, and the degree of bundle compactness. The intermalleolar ligament appeared as a thick string or as more than two fine parallel stripes on coronal MR images and as a linear structure on axial images. On sagittal images, the ligament appeared as scattered dots in the medial part and as a thin flat or nodular structure in the lateral part. CONCLUSION: The intermalleolar ligament seemed to be an almost invariably present anatomic entity with diverse morphologic features on MR images.     

Transitional cell carcinoma with metastases to spermatic vein and spermatic cord: PET/CT imaging

Transitional cell carcinoma of the kidney with venous tumor thrombus is uncommon with only a limited number of cases published in the medical literature. The authors present a case of renal urothelial carcinoma with PET/CT imaging. PET, in addition to the demonstration of tumor thrombus in the left renal vein and inferior vena cava, showed a thrombosed left spermatic vein with metastases to the left spermatic cord and epidydimis.