{"id":117,"date":"2024-04-19T10:28:15","date_gmt":"2024-04-19T08:28:15","guid":{"rendered":"https:\/\/www.embonice.com\/?page_id=117"},"modified":"2024-04-19T10:28:16","modified_gmt":"2024-04-19T08:28:16","slug":"embolisation-de-varicocele","status":"publish","type":"page","link":"https:\/\/www.embonice.com\/index.php\/embolisation-de-varicocele\/","title":{"rendered":"Embolisation de varicoc\u00e8le"},"content":{"rendered":"\n
Une varicoc\u00e8le est une dilatation du r\u00e9seau veineux p\u00e9ri-testiculaire, le plus souvent du c\u00f4t\u00e9 gauche, \u00e0 cause d\u2019une incomp\u00e9tence de la veine spermatique gauche, le sang circulant \u201c\u00e0 contre-sens\u201d, \u00e0 l\u2019origine d\u2019une stase sanguine testiculaire.<\/p>\n\n\n\n
Souvent asymptomatique, une varicoc\u00e8le peut \u00eatre \u00e0 l\u2019origine de pesanteur testiculaire, de douleurs, principalement en fin de journ\u00e9e, voire de troubles de la fertilit\u00e9 avec anomalies du spermogramme.<\/p>\n\n\n\n
Principe de l\u2019embolisation<\/em><\/strong><\/p>\n\n\n\n
L\u2019embolisation consiste \u00e0 boucher la veine spermatique incomp\u00e9tente, \u00e0 l\u2019aide de colle m\u00e9dicale ou de spirs m\u00e9talliques (co\u00efls), en vue d\u2019interrompre le reflux sanguin au sein des veines p\u00e9ri-testiculaires, et de rediriger le sang vers des veines comp\u00e9tentes.<\/p>\n\n\n\n
Le circuit patient et la proc\u00e9dure en d\u00e9tails<\/em><\/strong><\/p>\n\n\n\n
L\u2019indication d\u2019embolisation est confirm\u00e9e lors d\u2019une consultation d\u00e9di\u00e9e de radiologie interventionnelle, apr\u00e8s r\u00e9alisation d\u2019un \u00e9cho-doppler testiculaire.<\/p>\n\n\n\n
Le geste se d\u00e9roule sous anesth\u00e9sie locale voire s\u00e9dation l\u00e9g\u00e8re.<\/p>\n\n\n\n
Une consultation d\u2019anesth\u00e9sie doit \u00eatre r\u00e9alis\u00e9e.<\/p>\n\n\n\n
Le jour de l\u2019intervention, le patient est re\u00e7u au bloc de radiologie interventionnelle, puis install\u00e9 sur le dos.<\/p>\n\n\n\n
Apr\u00e8s anesth\u00e9sie locale, le radiologue effectue une ponction veineuse, le plus souvent au niveau d\u2019une veine superficielle du bras (veine basilique), parfois au niveau d\u2019une veine f\u00e9morale au pli de l\u2019aine.<\/p>\n\n\n\n
Un cath\u00e9ter (petit tuyau) est ensuite introduit au sein de la veine ponctionn\u00e9e, permettant au radiologue de naviguer dans le r\u00e9seau veineux du patient, jusqu\u2019\u00e0 la veine spermatique gauche.<\/p>\n\n\n\n
Une injection de produit de contraste iod\u00e9 permet de rep\u00e9rer pr\u00e9cis\u00e9ment cette veine spermatique, de confirmer son caract\u00e8re refluant donc pathologique (circulation \u00e0 contre sens), et d\u2019y introduire le cath\u00e9ter.<\/p>\n\n\n\n
Lorsque le cath\u00e9ter est parfaitement positionn\u00e9 au sein de la veine spermatique, le radiologue proc\u00e8de \u00e0 l\u2019embolisation \u00e0 proprement parler, par injection de colle m\u00e9dicale, de scl\u00e9rosant, ou de coils.<\/p>\n\n\n\n
Un contr\u00f4le final confirme l\u2019obstruction et l\u2019absence de reflux au sein de la veine embolis\u00e9e.<\/p>\n\n\n\n
Le mat\u00e9riel est retir\u00e9, et le point de ponction est comprim\u00e9 quelques minutes.<\/p>\n\n\n\n
La dur\u00e9e de l\u2019intervention est d\u2019environ 30-45 minutes.<\/p>\n\n\n\n
Le patient est surveill\u00e9 durant 1 \u00e0 2h au d\u00e9cours de la proc\u00e9dure avant retour au domicile.<\/p>\n\n\n\n
Les complications per-op\u00e9ratoires sont tr\u00e8s rares. <\/p>\n\n\n\n
Un h\u00e9matome peut survenir au point de ponction, ainsi qu\u2019une r\u00e9action allergique aux agents inject\u00e9s. <\/p>\n\n\n\n
En cas d\u2019utilisation de colle m\u00e9dicale, des cas exceptionnels de migration vers les art\u00e8res du poumon ont \u00e9t\u00e9 d\u00e9crits, le plus souvent asymptomatiques.<\/p>\n\n\n\n<\/figure>\n\n\n\n
Illustration de la proc\u00e9dure par la Soci\u00e9t\u00e9 fran\u00e7aise de radiologie (SFR)<\/em><\/p>\n\n\n\n
Des douleurs du bas ventres et du testicules embolis\u00e9 sont classiques dans les jours qui suivent l\u2019intervention, bien contr\u00f4l\u00e9es par antalgiques classiques.<\/p>\n\n\n\n
Au d\u00e9cours,l\u2019efficacit\u00e9 sur les douleurs pr\u00e9-op\u00e9ratoire est en g\u00e9n\u00e9ral observ\u00e9e tr\u00e8s rapidement. <\/p>\n\n\n\n
Dans le cadre de troubles de la fertilit\u00e9, il faut 2 \u00e0 3 mois pour un effet sur la qualit\u00e9 du sperme.<\/p>\n\n\n\n
Une consultation de suivie avec la radiologue est pr\u00e9vue quelques mois apr\u00e8s l\u2019intervention.<\/p>\n","protected":false},"excerpt":{"rendered":"
Une varicoc\u00e8le est une dilatation du r\u00e9seau veineux p\u00e9ri-testiculaire, le plus souvent du c\u00f4t\u00e9 gauche, \u00e0 cause d\u2019une incomp\u00e9tence de la veine spermatique gauche, le sang circulant \u201c\u00e0 contre-sens\u201d, \u00e0 l\u2019origine d\u2019une stase sanguine testiculaire. Souvent asymptomatique, une varicoc\u00e8le peut \u00eatre \u00e0 l\u2019origine de pesanteur testiculaire, de douleurs, principalement en fin de journ\u00e9e, voire de […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-117","page","type-page","status-publish","hentry","entry"],"yoast_head":"\n
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