Department of Anatomy, Sapienza University of Rome, Rome, Italy.
J Vasc Surg. 2011 Dec;54(6 Suppl):56S-61S. doi: 10.1016/j.jvs.2011.06.031. Epub 2011 Aug 6.
The higher prevalence of venous disorders in the left lower limb is currently ascribed to compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA). This study evaluated the occurrence of LCIV compression by the left common iliac artery (LCIA).
The anatomy of iliac vessels was evaluated by computed tomography (CT) in 100 asymptomatic individuals. Traditional axial projections, multiple planar, and curved planar reconstructions were used to investigate LCIV morphology.
Compression of the LCIV by the LCIA was found in 20% of participants, whereas compression by the RCIA occurred in 25% and by both iliac arteries in 21%. Axial projections demonstrated a mean reduction in caliber of the LCIV at LCIA crossing of 22.25% (range 0%-90%). Caliber reduction of >20%, 50%, and 70% was observed in 41, 21, and 6 individuals, respectively. The mean LCIV reduction in caliber at RCIA crossing calculated in the axial CT was 24.49% (range, 0%-95%). Caliber reduction of >20%, 50%, and 70%, was observed in 46, 22, and 5 subjects, respectively. Multiple planar reconstructions demonstrated that in contrast to the RCIA, the compressive LCIA determines an eccentric deformation of the vein along its major axis, thus inducing a marked distortion of the lumen that varies from 22 to 37 mm.
LCIV compression by the LCIA occurs in a relevant number of asymptomatic individuals and compression by the RCIA coexists in about one-half. The patterns of compression by LCIA correlate well with venographic and anatomic findings, which demonstrated damage of the LCIV unrelated to the RCIA crossing. Further investigations are needed to evaluate the hemodynamic and pathophysiologic implications of such compressive relationships. In fact, even if not necessarily associated with chronic venous disorders, LCIV compression by the overlying arteries must be considered a condition "permissive" of future development of chronic congestion or iliofemoral thrombosis.
左下肢静脉疾病的高发率目前归因于左髂总静脉（LCIV）被右髂总动脉（RCIA）压迫。本研究评估了左髂总动脉（LCIA）对 LCIV 压迫的发生情况。
通过计算机断层扫描（CT）评估 100 名无症状个体的髂血管解剖结构。使用传统轴位投影、多平面和曲面重建来研究 LCIV 形态。
在 20%的参与者中发现 LCIV 被 LCIA 压迫，而 25%的参与者被 RCIA 压迫，21%的参与者同时被两侧髂动脉压迫。轴位投影显示，LCIA 交叉处 LCIV 的口径平均减少 22.25%（范围 0%-90%）。在 41、21 和 6 名患者中分别观察到口径减少>20%、50%和 70%。在轴向 CT 计算的 RCIA 交叉处，LCIV 口径平均减少 24.49%（范围，0%-95%）。在 46、22 和 5 名患者中分别观察到口径减少>20%、50%和 70%。多平面重建显示，与 RCIA 不同，压迫性 LCIA 沿其长轴使静脉发生偏心变形，从而导致管腔明显扭曲，范围从 22 到 37 毫米不等。
LCIV 被 LCIA 压迫在相当数量的无症状个体中发生，而 RCIA 压迫约占一半。LCIA 压迫的模式与静脉造影和解剖学发现非常吻合，这些发现表明 LCIV 的损伤与 RCIA 交叉无关。需要进一步研究来评估这种压迫关系的血流动力学和病理生理意义。事实上，即使与慢性静脉疾病不一定相关，LCIV 被上方动脉压迫也必须被视为未来发生慢性充血或髂股静脉血栓形成的“许可”条件。
