[Varicoceles, pelvic varices and pelvic congestion syndrome: Interventional radiology in diagnosis and treatment]. / Varicocèles, varices pelviennes et syndrome de congestion pelvienne : place de la radiologie interventionnelle.

Genital venous insufficiency in men is usually of constitutional origin due to valvular incontinence. Genital venous insufficiency in female is more often generated by major, lasting, and possibly repeated pregnancy-related hyperpressure phenomena. Genital venous insufficiency in men is usually expressed by visible and recognizable peritesticular varicocele. Of simple anatomic structure, it is easily accessible to endovascular treatment by embolization, which is the first-line therapy nowadays. Genital venous insufficiency in women results in a pelvic predominant varicosis, which should be evoked in case of chronic pelvic pain or atypical venous afferents to the lower limbs. Precise and guided interrogation and clinical examination allow the attending physician to be the first actor in the detection of symptomatic pelvis venous insufficiency in men and women. A chronic pelvic pain in female should evoke a pelvic congestion syndrome, symptomatic translation of pelvic varicosis, especially if it increases at the end of the day, at the effort, in pre-menstrual period. Treatment with endovascular embolization is the only therapeutic option for female pelvic venous insufficiency, of complex architecture and deep anatomical situation. The interventional radiologist offers a complete, minimally invasive and efficient treatment with limited hospital costs and perioperative constraints.

Uterine Artery Embolization for Retained Products of Conception with Marked Vascularity: A Safe and Efficient First-Line Treatment.

OBJECTIVE: To report our clinical practice regarding a case series of retained products of conception (RPOC) with marked vascularity (MV) managed with selective uterine artery embolization (UAE) as first-line treatment. METHODS: This was a monocentric, retrospective study of 31 consecutive cases of RPOC with MV diagnosed by Doppler ultrasound in the context of postpartum/postabortal bleeding. The primary outcome was the absence of rebleeding following embolization. RESULTS: RPOC with MV occurred after abortion in 27 out of 31 patients (87%). The time elapsed between delivery/abortion and UAE ranged from 1 to 210 days (mean 55.7 ± 45 days). Primary clinical success was achieved in 23 women (74.2%) following a single embolization. In total, 27 out of 31 women (87%) had been exclusively managed by UAE with conservative success. Although procedural success was achieved in this number, six women had a further procedure to evacuate RPOC despite procedural success. Large uterine arteriovenous (AV) shunts associated with RPOC were observed in five cases (16.1%), among which two were successfully treated after a single UAE and one after two UAEs, while hysterectomy was performed in the last two cases despite two and three UAE procedures respectively. RPOC was histologically proven in ten cases (32.2%) including four out of five cases of uterine AV shunt. CONCLUSION: RPOC with MV can present with large uterine AV shunt, particularly in case of late management. Uterine artery embolization is an effective and safe first-line treatment, and should be evaluated for this indication in larger prospective trials.

Estimation of the functional role of arterial pathways to the buttock circulation during treadmill walking in patients with claudication.

The aim of the study was to estimate the functional contribution of the arterial inflow pathways to the pelvic circulation during walking in patients with stage 2 lower extremity arterial disease. Transcutaneous oxygen pressure (Ptc(O(2))) changes during exercise can be used to estimate the severity of regional blood flow impairment while walking. Seventy patients with stable lower limb claudication were studied using a multivariate linear regression model. The relationship between exercise-induced buttock Ptc(O(2)) changes, the ipsilateral calf Ptc(O(2)) changes, and the arterial diameters of the pelvic arteriographic pathways were analyzed. The ipsilateral hypogastric and lumbar pathway, as well as the ipsilateral calf Ptc(O(2)) changes, were the only variables significantly related to buttock Ptc(O(2)) changes (r = 0.47; P < 0.001). Their normalized respective contribution to the regressive model was 39%, 19%, and 18%. None of the contralateral hypogastric, mesenteric, and sacral pathways or pathways stemming from the external iliac artery showed significant correlation to buttock Ptc(O(2)) changes. The ipsilateral hypogastric and ipsilateral lumbar pathways are the major pathways responsible for the functional buttock blood flow supply during walking. The role of contralateral hypogastric, inferior mesenteric, and median sacral pathways and arteries distal to the internal iliac trunk is negligible in the normal or compensatory blood flow supply. Distal Ptc(O(2)) decrease at exercise aggravates proximal Ptc(O(2)) decrease, possibly through the occurrence of a "steal phenomenon" of distal over proximal circulation during walking.

Transcutaneous oxygen pressure measurements on the buttocks during exercise to detect proximal arterial ischemia: comparison with arteriography.

BACKGROUND: We sought to identify whether transcutaneous oxygen tension (tcPo2) measurements could be used to noninvasively detect lesions in the arterial network supplying blood flow to the hypogastric circulation. METHODS AND RESULTS: A study was undertaken in vascular patients with suspected (PC, n=43) and not with suspected (NPC, n=34) proximal ischemia. TcPo2 was measured on both buttocks and with a chest reference electrode. Arteriography on the right or left side was positive for stenoses (> or =75%) or occlusion of one or more of the following arteries: the aorta, the common iliac arteries, or the internal iliac arteries. The arteriography was compared with the resting tcPo2 values (REST) and with the minimal value (MIN) and maximal change from rest normalized to eventual chest changes (DROP) recorded during or after a treadmill test. REST, MIN, and DROP were, respectively, as follows in positive versus negative arteriograms (mean+/-SD; in mm Hg): 80.2+/-10.9 versus 78.6+/-11.5 (P>0.05), 55.2+/-20.0 versus 69.9+/-15.8 (P<0.001), and -31.8+/-17.6 versus -9.5+/-6.4 (P<0.0001) in PC and 78.9+/-14.0 versus 80.5+/-14.3 (P>0.05), 64.4+/-21.0 versus 75.1+/-14.6 (P<0.02), and -24.1+/-13.5 versus -8.7+/-4.8 (P<0.0001) in NPC. In PC and NPC respectively, with a cutoff point of -16 and -15 mm Hg, DROP showed, respectively, 83%/82% and 79%/86% sensitivity/specificity in the diagnosis of positive arteriograms. CONCLUSIONS: Proximal ischemia is a frequent finding in vascular patients. TcPo2 measurement on the buttocks during exercise is a sensitive and specific indicator for lesions in the arterial tree toward the hypogastric circulation. Potentially it could objectively assess the response to endovascular or surgical approaches to iliac lesions.