Anastomoses between the spermatic and visceral veins:a retrospective study of 500 consecutive patients

Abstract

Visceral-spermatic vein communications are classified by number, morphology, and site. Percutaneous sclerotherapy could be optimized when performed caudally to these communications.

Ischemic colitis following left antegrade sclerotherapy for idiopathic varicocele

“…The scarcity of such references contrasts with the published epidemiological data, which reveal abnormal communications between the left colic and left testicular veins in 7.8% (Salerno et al, ) to 9.2% (Bigot et al, ) of cases, described as a venous trunk with competent valves (5.1%), or communicating venules (3.1%), or single/double anastomoses (1%), with only an outline estimate (77%) reported by Wishahi (). However, despite the hypothetical prevalence of this anatomical variation, some urologists and interventional radiologists report that they cannot correctly visualize it by intraoperative phlebography, although they are aware of its possible presence and check carefully (Fulcoli et al, ; Vicini et al, ).…”

“…As previously stated (Lechter et al, ), modern anatomy textbooks often mention anatomical variations and atypical communications of the above‐mentioned portal‐systemic anastomoses only summarily, rarely stressing the anastomotic communication between the left colic vein (portal system) and left testicular vein (systemic). Nevertheless, this anastomosis is clinically relevant in daily practice for clinicians and surgeons (Bigot et al, ). (a) Anastomoses between the gonadal and portal venous systems are commonly recognized by surgeons as small collateral veins that bleed readily during dissection of the colonic fascia (Donovan and Winfield, ), (b) Whenever there is thrombosis in the mesenteric venous system it causes necrosis of the small bowel more frequently than necrosis of the colon, possibly because of a number of anastomoses between the gonadal and colonic veins (Cokkinis, ), (c) Likewise, mesenteric infarction causes proximal rather than distal necrosis, and ligature of the superior mesenteric vein can be uneventful when performed on patients with a preexisting occlusion of the portal vessels (Linton, ), (d) Moreover, asymptomatic portal thrombosis extending to the distal part of the gonadal veins has been reported in patients with acute colonic inflammatory disease, diverticulitis, Crohn's disease, ulcerative colitis, pseudomembranous colitis, and appendicular abscess (Jain and Jeffrey, ).…”

“…There have been specific references to this particular anastomosis in more dated textbooks since the 19th century (Cruveilhier, ; Hovelacque, ; Paturet, ), but rarely in recent clinical textbooks (Grieme and Venbrux, ; Basu, ) or scientific papers (Bigot et al, ; Wishahi, ; Chudnovets et al, ). Conversely, left‐sided gonadal‐mesenteric inferior anastomoses were observed in 21% of cases in human fetuses, an ovarian‐mesenteric inferior anastomosis in 24%, and a testicular‐mesenteric inferior anastomosis in 19% (Szpinda et al, ).…”

“…On this point a number of authors have reported that multiple aberrant anastomoses could be present simultaneously between the testicular vein and nearby veins, including the left colic vein (Lechter et al, ; Wishahi, ; Bigot et al, ). It was not recognizable by intraoperative phlebography because of competent valves, as reported in up to 55% of cases by some authors (Bigot et al, ), which were destroyed when the sclerosing substance was injected, also causing vein coarctation, so it was no longer detectable on a CT scan after the complication occurred, albeit at short distance. Vicini et al () reported an interesting intraoperative phlebography apparently showing the unidentified proximal tract of a collateral between the left testicular and left colic veins (Figure in their article).…”

Contribution to the Pathophysiology and Treatment of Varicoceles

“…Most studies based on venography and with large number of patients report a bilateral varicocele in 25% [8][9][10]. In studies using different diagnostic tools, bilateral varicocele was reported in a range between 40% and 60% [11][12].…”