Ro Ayako, Kageyama Norimasa, Mukai Toshiji
Department of Legal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Tokyo Medical Examiner's Office, Tokyo, Japan.
Ann Vasc Dis. 2017 Jun 25;10(2):99-106. doi: 10.3400/avd.ra.17-00035.
Here the pathophysiology of venous thromboembolism is reviewed with respect to the anatomical features of the deep veins of lower limbs. A thrombus is less likely to form in the thigh veins compared with that in the calf veins; however, clinical symptoms are more likely to appear in the thigh veins owing to vascular occlusion. When a patient is bedridden, thrombosis is more likely to occur in the intramuscular vein, which mainly depends on muscular pumping and the venous valve, rather than in the three crural branches, which mainly depends on the pulsation of the accompanying artery. Thrombi are prone to be generated in the soleal vein compared with those in the gastrocnemius vein because of the vein and muscle structures. A soleal vein thrombosis grows toward the proximal veins along the drainage veins. To prevent a sudden pulmonary thromboembolism-related death in bedridden patients, preventing soleal vein thrombus formation and observing the thrombus proximal propagation via the drainage veins are clinically important. When deep vein thrombosis occurs, avoiding embolization and sequela caused by the thrombus organization is necessary.
本文结合下肢深静脉的解剖学特征，对静脉血栓栓塞症的病理生理学进行了综述。与小腿静脉相比，大腿静脉形成血栓的可能性较小；然而，由于血管阻塞，大腿静脉更易出现临床症状。患者卧床时，血栓更易发生于主要依赖肌肉泵血和静脉瓣膜的肌内静脉，而非主要依赖伴行动脉搏动的三条小腿分支静脉。由于静脉和肌肉结构的原因，与腓肠肌静脉相比，比目鱼肌静脉更容易形成血栓。比目鱼肌静脉血栓沿引流静脉向近端静脉发展。为防止卧床患者突然发生与肺血栓栓塞相关的死亡，预防比目鱼肌静脉血栓形成并通过引流静脉观察血栓向近端蔓延在临床上具有重要意义。当发生深静脉血栓形成时，避免血栓机化导致的栓塞和后遗症是必要的。
