Selective Angiography of the Ovarian Artery

Abstract

The recent generalization that one-third of the important decisions in the cases of sick patients are based on radiologic judgments (10) does not include gynecology. The gynecologist requests proportionately fewer radiologic consultations. This is in part because his work allows direct examination, and in part because standard x-ray examinations are generally not informative in problem cases. However, the “clinical examination of pelvic viscera is occasionally inadequate and often inaccurate, even when performed by experienced physicians. In a review of 300 consecutive pelvic laparotomies, it was found that nearly half of the time the preoperative pelvic examination was incorrect or incomplete” (11). Partial answers to this problem have been provided by hysterosalpingography and pelvic pneumography. But according to Lang (7) “the single most important advance toward an accurate preoperative diagnosis of pelvic tumors can be attributed to pelvic angiography.” Unfortunately, a high proportion of such studies have been nondiagnostic in the study of adnexal masses (1). For the adnexal branch of the uterine artery as studied in a series of 326 pelvic arteriograms was visualized in only 69, and in the majority of these 69, only on one side. In a later study (2) ovarian arteries were visualized in only 20 per cent of patients examined by standard aortographic technics. It should be emphasized that five-sevenths of those patients had major pelvic pathology. With aortic compression, 10 of 16 patients showed opacification of ovarian arteries, but this technic was abandoned because of renal complications (2). Borell and Fernström concluded that angiography without compression sueceeded in demonstrating the ovarian artery in only a small number of cases and was of diagnostic value in only 2 of 77 patients with pelvic pathology. We think that selective ovarian angiography is a diagnostic procedure that will provide the gynecologist with precise anatomic information of value in the study of adnexal masses. Materials Selective studies of 12 ovarian arteries are presented for analysis. Eight patients had unilateral and two had bilateral studies. Three patients with trophoblastic disease of the placenta were studied and a correct diagnosis was made in each from the angiograms independent of laboratory values. One patient with a proved choriocarcinoma was restudied after cancer chemotherapy. In another, the angiographic diagnosis of benign mole was confirmed by histologic study. One clinically diagnosed ovarian tumor was studied (Fig. 1) and then histologic diagnosis of a serous cystadenoma was obtained. Two unsuspected adnexal masses were discovered by angiography. In four patients, the ovarian arteries were studied as a potential renal collateral or as the blood supply to a possible retroperitoneal mass.