Gonadal Vein Embolization: Treatment of Varicocele and Pelvic Congestion Syndrome

Vanderbilt University and Vanderbilt Children's Hospital, Nashville, Tennessee.
Seminars in Interventional Radiology 09/2008; 25(3):261-70. DOI: 10.1055/s-0028-1085927
Source: PubMed


Therapeutic embolization of the gonadal veins is performed on male and female patients for different clinical situations using similar techniques. The testicular varicocele is a common clinical problem associated with pain and reduced fertility rates. In women, chronic pelvic pain can be attributed to pelvic congestion syndrome, which is said to result from retrograde flow in incompetent ovarian veins. Both of these clinical problems respond well to gonadal vein embolization. In this article, we review the clinical evaluation, diagnostic workup, and technical aspects of percutaneous intervention of gonadal vein embolization. The supporting literature is also reviewed.

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    • "Multiple venous collateral communications may arise, usually between the gonadal vein origin and deep inguinal ring. These are parallel or perpendicular to the gonadal vein and may include retroperitoneal, perirenal, and lumbar veins [6] [7]. Development of varicocel in portal hypertension can be explained as portosystemic shunt that provides salvage pathways for increasing portal pressure [2] [3] [8]. "
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    ABSTRACT: Isolated giant varicocele has been reported with portal hypertension that results in abnormal communication between portal venous system and testicular vein venous system resulting in retrograde backflow of blood into the testicular venous system which leads to varicosity of the pampiniform plexuses. 65-year-old male with no past medical or surgical history presented to us with soft inguinoscrotal swelling that disappears on lying down mimicking inguinal hernia. Clinical examination revealed soft inguionoscrotal swelling that disappears on pressure. Ultrasonography revealed varicosity of pampiniform plexus, and CT angiography to trace the extent of the varicosity revealed abnormal communication of right testicular vein with superior mesenteric vein. There was no evidence of any portal hypertension; the cause of the portosystemic shunt remains obscure, and it might be a salvage pathway for increasing portal pressure. The case is noteworthy for its rare presentation and abnormal communication with portal venous system in the absence of evidence of portal hypertension.
    02/2013; 2013:709835. DOI:10.1155/2013/709835
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    K.Ammer ·
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    ABSTRACT: This paper is an update of a report which information on Thermology is available on the internet. In total three searches were performed, one in the standard version of Google using the search term “thermology”. Google Scholar and Embase was searched for “thermography” and “clinical”and “medicine” both restricted to the year 2008. 572 links to websites related to thermology were found, but none of the previously published web adresses were re-identified. Many hits in Google were linked with thermographic services, mainly infrared breast imaging. Some findings were linked to academic thermology societies. The scientific impact of journals publishing papers on temperature related topics is discussed in brief. The searches for publications on thermography and clinical medicine found that only 31 of 174 papers identified in Embase were also found in Google Scholar. After combining the results from Embase with publications traced by the first 200 hits of the search in Google Scholar, 242 papers were related to clinical medicine, 10 to veterinary medicine and the the remaining 74 to applied sciences. Many medical papers discussed the use of thermography in patients with complex regional pain syndrome, in vascular disease and in surgery. In conclusion, the current literature on medical thermal imaging shows similar use of the technique as last years review. Searching for scientific papers in Google or Google Scholar, obtained mediocre scientific information only, despite a large number oft hits.
    Thermology International 01/2009; 19(1):15-28.
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    ABSTRACT: Varicoceles are often treated with percutaneous embolization, using fibered coils and sclerosing agents, with the latter targeted at occlusion of pre-existing collateral veins. While various methods of surgical and embolization treatment are available, varicoceles may still recur from venous collateralization. We present a case, where following demonstration of complete occlusion of the right and left gonadal veins, direct puncture of the pampiniform venous plexus under ultrasound guidance revealed recurrent varicoceles supplied by anastomoses from the ipsilateral saphenous and femoral veins to the pampiniform plexus. In doing so, we describe a technique of percutaneous pampiniform venography in a case where the pertinent anatomy was not easily demonstrated by other methods.
    07/2011; 3(7):194-8. DOI:10.4329/wjr.v3.i7.194
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