Pieri S, Agresti P, Fiocca G, Regine G
U.O. C. di Radiologia Vascolare ed Interventistica, Azienda Ospedaliera "S. Camillo-Forlanini", Roma, Italy.
Radiol Med. 2006 Jun;111(4):551-61. doi: 10.1007/s11547-006-0050-3. Epub 2006 May 25.
Male varicocele is a clinical dysfunction caused by a pathological venous reflux. Knowledge of anatomic variants of the internal spermatic vein confluence is fundamental for the technical success of percutaneous treatment. While numerous studies have analysed the phlebographic anatomy of the left internal spermatic vein, no exhaustive description exists for the right internal spermatic vein.
From a retrospective review of 3229 patients treated percutaneously between 1988 and 2003, we extrapolated the phlebographic images of patients with incontinence of the right internal spermatic vein only. Mean patient age was 24.6 (range 14-46) years. Indication for treatment was presence of pain in the right inguinal region and absence of a history of trauma and/or seminal-fluid alterations. Phlebography had been performed with transbrachial access using a tilt table and a multipurpose angiographic catheter. Contrast medium was injected into both the inferior vena cava and the renal vein. Selective catheterisation of the internal spermatic vein was then performed to assess the radiological characteristics of the vessels prior to sclerosis.
There were 93 cases of incontinence of the right internal spermatic vein only (2.8%). In the first group of patients (seven cases, 7.5%), the right internal spermatic vein drained exclusively into the renal vein; the injection of contrast medium during a Valsalva manoeuvre allowed visualisation of the vein almost as far as the iliac level. In most cases, the vein appeared uniformly dilatated and without valvular systems along its course. In the second group (21 cases, 22.5%), the vein drained into both the renal vein and the inferior vena cava, with one branch showing functional predominance over the other: selective catheterisation was easier to perform on the first branch. Selective catheterisation confirmed dilatation of the vein as well as the absence of valvular systems. In most patients, (65 cases, 69.8%), the internal spermatic vein drained into the inferior vena cava; the confluence was double in five patients and single in 60 patients. Visualisation of incontinence was limited to the initial 5-10 cm of the vein in 13 cases; however, vein dilatation and absence of valvular systems were confirmed beyond the semicontinent valve.
Interventional treatment is one of the therapeutic options for male varicocele, but the method is limited by the presence of anatomic variants or aberrant supplying vessels, which make catheterisation and sclerosis of the internal spermatic vein difficult if not impossible. Interventional radiologists must have a thorough knowledge of anatomic variants of the right internal spermatic vein to be able to perform the procedure within a reasonable amount of time and reduce radiation exposure.
男性精索静脉曲张是一种由病理性静脉反流引起的临床功能障碍。了解精索内静脉汇合处的解剖变异对于经皮治疗的技术成功至关重要。虽然众多研究分析了左侧精索内静脉的静脉造影解剖结构，但对于右侧精索内静脉尚无详尽描述。
通过回顾性分析1988年至2003年间接受经皮治疗的3229例患者，我们提取了仅右侧精索内静脉功能不全患者的静脉造影图像。患者平均年龄为24.6岁（范围14 - 46岁）。治疗指征为右侧腹股沟区疼痛且无创伤史和/或精液改变史。静脉造影采用经肱动脉途径，使用倾斜台和多功能血管造影导管进行。将造影剂注入下腔静脉和肾静脉。然后对精索内静脉进行选择性插管，以在硬化治疗前评估血管的放射学特征。
仅右侧精索内静脉功能不全的病例有93例（2.8%）。在第一组患者（7例，7.5%）中，右侧精索内静脉仅汇入肾静脉；在瓦尔萨尔瓦动作期间注入造影剂可使静脉几乎在髂静脉水平显影。在大多数情况下，静脉全程呈均匀扩张且无瓣膜系统。在第二组（21例，22.5%）中，静脉汇入肾静脉和下腔静脉，其中一个分支较另一个分支功能上占优势：对第一个分支进行选择性插管更容易。选择性插管证实静脉扩张且无瓣膜系统。在大多数患者（65例，69.8%）中，精索内静脉汇入下腔静脉；5例患者的汇合处为双支，60例患者为单支。13例患者中，功能不全的显影仅限于静脉起始的5 - 10厘米；然而，在半月瓣之外证实静脉扩张且无瓣膜系统。
介入治疗是男性精索静脉曲张的治疗选择之一，但该方法受解剖变异或异常供血血管存在的限制，这使得精索内静脉插管和硬化治疗即便不是不可能，也会变得困难。介入放射科医生必须全面了解右侧精索内静脉的解剖变异，以便能够在合理时间内完成操作并减少辐射暴露。
