Compression of the common iliac vein by the common iliac artery, resulting in impaired blood return to the deep veins of the lower extremities, is known as common iliac vein compression syndrome. This is a rare disease, which has only been recognized and paid attention to in recent years.
1.Etiology and pathology.
The common iliac vein compression syndrome is due to anatomical abnormalities. The abdominal aorta is located on the left side of the inferior vena cava. The confluence of the inferior vena cava and the left and right common iliac veins is in front of the upper edge of the 5th lumbar vertebra, and the inferior vena cava and the left common iliac vein are located in the anterior convex part of the sacral headland, in front of which the right common iliac artery passes, which can compress the left common iliac vein and form a fibrous band between the artery and the vein, or form intimal webbing or adhesions within the vessel, affecting the venous blood return to the left lower limb. This not only tends to cause deep vein thrombosis, but also non-inflammatory edema.
According to Chinese medicine, this disease is caused by damp-heat injection and blood stasis in the meridians, resulting in purple and black muscles, pain and itching, or due to wind-heat and damp toxin gathering, or due to congenital deficiency, abnormal fertility, combined with long standing and long-distance travel strain, or due to evil guests outside the veins, resulting in poor blood flow and blood stasis in the meridians.
2.Clinical manifestations and signs
The common symptom is unexplained edema. The swelling is actually caused by the compression of the left common iliac vein, which has nothing to do with exercise, but it is obvious when menstruation or hot weather occurs, but there is no pain.
3. Auxiliary examinations.
(1) Left femoral vein cannulation angiography or left and right femoral vein cannulation angiography shows: indentation at the confluence of the left common iliac vein and inferior vena cava by the right common iliac artery; widening of the left common iliac vein with delayed emptying of contrast medium; many collateral circulation around the left common iliac vein.
(2) Pressure measurement examination: after left femoral vein cannulation contrast, the catheter was continued to be inserted in the direction of the vena cava, and when it was inserted to the level of the third lumbar vertebra, that is, the proximal end of the common iliac vein compression, the pressure was measured and recorded, and then the catheter was withdrawn 3-4 cm, that is, the sacroiliac joint area, that is, the distal end of the iliac artery plane, the pressure was measured and recorded, and the number of pressure measurements in the 2 planes of the left iliac vein was compared, and the difference of its venous pressure was 19.6 Pa ( 2cmH2O) or more, which can help to diagnose.
4.Diagnosis and treatment.
The main point of identification of this disease is to distinguish deficiency from reality. The deficient patient has been ill for a long time, with swollen white legs, pain in the lower back and legs, heavy during menstruation, thin white tongue and moss, sunken thin pulse; the real patient has a new disease, with diffuse swollen and firm limbs, occasionally breaking infection, redness, swelling, heat and pain, with a yellow and greasy pulse.
(1) Damp-heat infusion evidence: swollen limbs, occasional swelling and pain, obvious during menstruation, light afterwards, fever if there is traumatic infection, red tongue, thin white fur, slippery pulse; treatment is recommended to clear heat and dampness, invigorate blood circulation and resolve blood stasis, the formula is used to add reduction of Ermiao San: Atractylodes, Atractylodes, Poria, Red Peony, Papaya, Fangqi, Angelica, Pierced Mountain A.
(2) Spleen and kidney yang deficiency: swelling and heaviness of the affected limbs, sore knees and cold, tiredness and weakness, little thirst, light tongue, thin white fur, slow pulse; treatment should be warming the kidney and strengthening the spleen, dampness and circulation, the formula is used to warm the yang and strengthen the spleen soup with addition and subtraction: ginseng, astragalus, angelica, poria, papaya, coix seed, white Fren, patchouli, clove; such as heat can be added with double flowers, gong ying, ding; heavy wet can be added with zedoary, che Qianzi; blood stasis heavy can be added with Andrographis paniculata, leech, tuyuan, rhubarb, etc.
(3) Chinese medicine water bath formula: 30 grams of Sumac, 30 grams of Safflower, 15 grams of Gentiana, 15 grams of Sichuan pepper, 15 grams of dried ginger and 30 grams of Park salt. After mixing the above medicines, soak them in cool water for 1 hour first. The standard of adding water should be soaked through about 5 cm of the dried herbs plane. After soaking, bring it to a boil with high heat. After boiling, then switch to slow simmering for 1 hour over medium-low heat. During the process of simmering, the herbs should be stirred continuously to make a full decoction. Pour the simmering liquid into a warming bottle with the help of a funnel and strainer. Add cool water to the dregs and boil the liquid for the second and third time according to the previous method. The decoction time can be shortened to half an hour after the second and third boiling. Pour the liquid from these three decoctions together into a warming bottle and set aside. Pour the resulting liquid into the bathing basin and bathe the whole lower limbs in the liquid after the temperature is suitable, twice a day for 30 minutes each time, which can promote collateral circulation, improve blood flow and reduce swelling of the lower limbs.
5.Western medical treatment.
(1) General treatment: The affected limb can be elevated appropriately, wrapped in an elastic bandage, and the root of the thigh (at the groin) is often subjected to hot physiotherapy to promote venous reflux in the lower limb and the establishment of collateral circulation.
(2) Surgical treatment.
①Principle: to restore blood return flow to the left common iliac vein smoothly; to prevent postoperative re-compression by the right common iliac artery.
②Methods.
Decompression: cut the right common iliac artery and reanastomose it after the left common iliac vein.
Phleboplasty: Remove the extravascular fibrous band compression and intravascular adhesions to restore the round lumen of the vein, and then place a bridging pad between the artery and vein to prevent the vein from being recompressed.
Fascial suspension: The artery is fixed to the psoas major muscle to protect the left common iliac vein from compression.