Presentation Authors: Peter Chin*, Laurencia Villalba, Sean Huang, Lovelace Osei-Tutu, Wollongong, Australia
Introduction: The etiology of varicoceles is not fully understood and issues such as Laterality (high incidence of left sided varicoceles), recurrence and treatment failure are not addressed with current theories. Left Common Iliac Vein Compression (LCIVC) between the Right Common Iliac Artery and the vertebra is also known as May-Thurner Syndrome (MTS). The results of early cadaveric and modern studies show an incidence of 20-49% for MTS in the general population (Female:Male 2:1). The Pampiniform plexus has collaterals to both the internal spermatic vein and the Internal Iliac Vein and led to our hypothesis that a varicocele may be a manifestation of MTS. The objective of this study was to document the incidence of MTS in a group of males with a varicocele and compare them to the incidence of MTS from a study group of asymptomatic men.
Methods: After Ethics approval, 21/25 males completed the investigations and were available for analysis. Duplex ultrasound was used to identify the presence and degree of LCIVC. In the vascular literature, LCIVC â‰¥25% is considered significant compression and LCIVC â‰¥50% is considered clinically significant compression (high risk of DVT and Chronic Venous Insufficiency). A recent study by Cheng L et al. (Compression Syndrome in an Asymptomatic Patient Population: A Prospective Study. Chin Med J 2017:130:1269-75) looked at 500 asymptomatic patients to document the incidence of MTS. The males (n=272) in this group were used as a control group for the expected incidence of LCIVC in asymptomatic males.
Results: 21 males with a varicocele (mean age=32.3 (17-71). The mean LCIVC was 60.5% (Median 63.1%, 26.7%-82.7%). The incidence for LCIVCâ‰¥25% in the asymptomatic male population was 80/272 (29.4%) but every male with a varicocele had a LCIVC â‰¥25% (21/21 100%, Fisher Exact < 0.0001, p < 0.01). Clinically significant compression (LCIVC â‰¥50%) occurred in 19/21(90%) of males with varicoceles, and only 19/272 (6.9%) of asymptomatic males (Chi-squared analysis showed a strongly significant result Ï‡2=120.4,p < 0.01).
Conclusions: This study is the first to correlate the presence of a varicocele with a significant incidence of MTS. The link between MTS and Chronic Venous Insufficiency, vulval varicosities, DVT and gonadal incompetence has been established in females, but a link between varicoceles and MTS in males has not been studied before. The results of this study strongly support an etiological link between varicocele and MTS with wider implications for treatment and understanding. The limitations of this study are the small sample size and the use of a published series as a control group. Further studies are warranted