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La malattia venosa cronica pelvica non post-trombotica (MVCPNPT) e un’entita patologica che merita di essere identificata perche riunisce un certo numero di patologie (compressione della vena renale sinistra, compressione delle vene iliache, reflusso nelle vene gonadiche e pelviche) che hanno una fisiopatologia comune e, spesso, segni e sintomi comuni. I pazienti si rivolgono, a seconda dei casi, a un medico generico o a uno specialista (nefrologo, ginecologo, medico vascolare ecc.). Il suo trattamento e essenzialmente endovascolare, realizzato dai radiologi o dai chirurghi esperti nelle tecniche di flebografia selettiva e nel trattamento endovenoso. Tratteremo di seguito, dopo brevi cenni di anatomia e di fisiopatologia, i metodi d’indagine e di trattamento delle diverse patologie, come anche le loro indicazioni. Bisogna tuttavia sottolineare che la malattia venosa cronica pelvica e misconosciuta o mal conosciuta; la sua diagnosi permetterebbe una migliore presa in carico terapeutica.

Objective: To present our experience with embolization of pelvic reflux routes in patients with recurrent varices after surgery (REVAS). Method: Single patient group study of patients with previous surgical treatment for varicose veins, with REVAS in Unidad de Angiología y Cirugía Vascular, Hospital Ruber Internacional, Madrid, España. Patients presenting with REVAS with pelvic venous insufficiency (PVI) documented per transvaginal colour duplex, undergoing selective pelvic venography, were treated with embolization of insufficient gonadal and hypogastric mainstem and collateral veins. Results: In all, 215 patients (89.9%) reported relief of pelvic pain and symptoms of lower extremity venous stasis six months postembolization; total relief in 120 (50.2%) and partial relief in 95 (39.7%). Conclusions: There is high incidence of PVI in patients with REVAS. Embolization of insufficient gonadal and hypogastric mainstem and collateral vessels is associated with significant relief of clinical signs and symptoms of pelvic and lower extremity venous stasis in patients with REVAS and PVI.

Pelvic congestion syndrome (PCS) is frequent and underestimated as both symptoms and signs are not specific. Furthermore, patients consult general practitioners as well as specialist gynaecologists, urologists, vascular surgeons and phlebologists who are frequently unaware of this condition. Investigation protocol must first eliminate other diseases with similar clinical disorders and then identify which veins are responsible for PCS related to compression or reflux. Selective venography is the more informative investigation but transvaginal ultrasound examination is a valuable screening test. Outcome analyses after endovenous treatment have been reported in several articles, but no randomized controlled trial is available for comparing various operative treatments knowing that most of them were undertaken after failure of medical treatment. In our experience, about two-thirds of patients were symptom-free after vein compression, stenting, or embolization at middle-term assessment.

We report the case of a 69 year-old female, with cardiac disease, hypertension, and chronic renal failure treated by hemodialysis; she had several episodes of gastrointestinal hemorrhage, which could not be diagnosed by conventional methods. Digital angiographic study demonstrated the exact cause: it allowed to localize an arterio-venous malformation. A right hemicolectomy was performed and the pathologic study showed the presence of an arteriovenous fistula. Three years later the patient is free of symptoms. We recommend digital angiography in cases of gastrointestinal hemorrhage of unknown or unclear etiology, particularly in patients in chronic renal failure, on the basis of the association of hemodialysis and arteriovenous malformation.

The incidence of clinically impalpable testes is approximately 20% in an undescended testes population (Levitt et al. 1978). When a testis is not palpable it may be absent or it may be located anywhere along the course of its embryologic descent from the level of the renal fossa to its exit from the inguinal canal. Different methods have been employed for the preoperative localization of these testes: pneumoperitoneography (Lunderquist and Rafstedt 1967), herniogram (Dwoskin and Kuhn 1973), selective testicular arteriography (Ben-Menachen et al. 1974), selective testicular phlebography (Jacobs 1969; Weiss et al. 1979), and sonography (Madrazo et al. 1979). For the last 3 years we have been using spermatic phlebography in cases of nonpalpable undescended testes.

A case of primary intestinal tuberculosis after renal transplantation is reported. The clinical presentation was recurrent isolated melena. The hemorrhage site was located by means of arteriography an