Venous interventions: embolization
Endovascular interventions make it possible to selectively block blood flow in pathologically altered vessels of the urogenital system. The procedure is performed under fluoroscopic guidance.
- Ovarian vein embolization: used for pelvic venous insufficiency when contrast reflux is observed. Access is often achieved via the right femoral vein. A special occluder (e.g., Amplatzer vascular plug) is placed into the lumen of the dilated vessel.
- Varicocele embolization: endovascular treatment of left-sided varicocele includes preliminary venography of the left testicular vein followed by occlusion of its lumen using multiple embolization coils.
Anatomical variants of the left testicular vein
To successfully perform interventional procedures such as embolization or sclerotherapy for idiopathic varicocele, it is crucial to understand the anatomical features of the left testicular vein (v. testicularis sinistra). There is a classification describing its relationship with the left renal vein (v. renalis sinistra), inferior vena cava (v. cava inferior), and retroperitoneal collaterals.
- Type 0 («Normal»): a single trunk originates from the pampiniform plexus and drains directly into the left renal vein at a right angle, without collaterals.
- Type I: the main trunk drains into the left renal vein, with a single parallel collateral that also drains into the renal vein, creating a bypass pathway.
- Type II: the trunk is accompanied by multiple parallel branches, with the upper third appearing as a dense plexus draining into the left renal vein.
- Type III: along with the main trunk, there is a collateral originating laterally and draining into retroperitoneal or lumbar veins (vv. lumbales).
- Type IV: a complex network of collaterals forms anastomoses with retroperitoneal veins at various levels.
- Type V: a large medial collateral crosses the retroperitoneal space and drains directly into the inferior vena cava, bypassing the renal vein.
Interventions for arterial pathologies
In addition to the venous system, interventional radiology methods are actively used to treat arterial pathologies:
- Benign prostatic hyperplasia (BPH): prostatic artery embolization is considered an effective primary treatment method, comparable to transurethral resection of the prostate (TURP).
- Renal artery stenosis: stenting and revascularization are used for atherosclerotic lesions.
- Resistant arterial hypertension: renal sympathetic denervation is performed.
- Fibromuscular dysplasia: percutaneous transluminal angioplasty is used, which is relevant even in pediatrics.
Briefly: answers to topical questions
What treatment methods exist for left-sided varicocele?
Observation and interventional radiology methods are used to treat left-sided varicocele.
- Observation — in asymptomatic cases, typically only observation and patient reassurance are required.
- Percutaneous sclerotherapy — an interventional radiology method used in the treatment of idiopathic varicocele.
- Embolization — an endovascular intervention; in left-sided varicocele embolization, occlusion of the vein lumen is performed using multiple embolization coils (multiple coils).
Which arteries are targeted during endovascular treatment of uterine fibroids?
The target vessels in the endovascular treatment of uterine fibroids are the uterine arteries. The procedure is called uterine artery embolisation (uterine artery embolisation). For selective catheterization of the target vessel, a coaxial catheter is advanced through the internal iliac artery. This ensures free blood flow for the delivery of the embolic agent and reduces the risk of spasm.
Class and exam questions
What is the essence of ovarian vein embolization?
The procedure involves blocking blood flow in the dilated left ovarian vein by placing a vascular occluder. Access is typically achieved via the right femoral vein.
How does Type I structure of the left testicular vein differ from normal (Type 0)?
Unlike the normal single-trunk structure, Type I features a single parallel collateral branch forming a bypass pathway and independently draining into the left renal vein.
What methods are used to treat atherosclerotic renal artery stenosis?
Endovascular revascularization methods such as stenting are used, and their efficacy is compared with conservative medical therapy.
What else to study on this topic
- Uterine artery embolization for symptomatic uterine fibroids
- The role of interventional radiology in managing postpartum hemorrhage
- Comparative analysis of prostatic artery embolization and TURP
- Diagnosis and treatment of pelvic venous insufficiency in women
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