RU2788899C1 - Method for examining the deep vein of the thigh with its variant anatomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: device for repairing the spring block of the NPP turbogenerator The invention relates to medicine, namely to vascular surgery, and can be used to assess the state of the deep femoral vein in its variant anatomy by ultrasonic duplex angioscanning. To do this, the study is carried out in the position of the patient lying on his back, a linear sensor is placed along the projection line of the femoral neurovascular bundle in the upper third of the thigh, while visualizing the place where the deep femoral vein flows into the femoral vein from the lateral side. Next, the sensor is passed along a line located at an angle of 90° to the projection line of the femoral neurovascular bundle in the lateral direction until it intersects with the line running from the anterior superior iliac spine to the lateral condyle of the thigh. After using the convex probe, scanning is carried out along the indicated line running from the anterior superior iliac spine to the lateral condyle of the thigh, down. Then a linear sensor is used again, which is placed along the projection line of the femoral neurovascular bundle in the upper third of the thigh, the place where the deep femoral vein flows into the femoral vein from the medial side is visualized. Next, a convex sensor is used, scanning is carried out down the projection line of the femoral neurovascular bundle, in the middle and lower third of the thigh, the sensor is carried out along a line located 2 cm medially to the projection line of the femoral neurovascular bundle, in the lower third of the thigh, 4 cm above medial femoral condyle, the sensor is placed at an angle of 120° to the projection line of the femoral neurovascular bundle, the patency of the deep femoral vein is assessed. Further, in the position of the patient lying on his stomach, a linear sensor is used, which is carried up along the vertical midline located in the popliteal region and on the back of the thigh, to the level of the middle third of the thigh, proximal to the level of the middle third of the thigh. After that, a convex probe is used, which is carried upwards, assessing the patency of the deep femoral vein.

EFFECT: invention makes it possible to determine the patency and state of blood flow in the deep femoral vein with variant anatomy.

1 cl, 10 dwg

Description

The invention relates to medicine, namely to vascular surgery, and can be used to assess the state of the deep femoral vein in its variant anatomy.

Deep vein thrombosis (DVT) of the lower extremities remains one of the most important problems of modern phlebology and vascular surgery. According to Rosstat, the incidence of DVT in the Russian Federation is 1.5-1.6 cases per 1000 population. The most dangerous complication of DVT is pulmonary embolism, which occurs with a frequency of 0.5-0.7 cases per 1000 population [1]. Therefore, high-quality diagnostics is of great practical importance.

The deep femoral vein (DFT) is the main tributary of the femoral vein, located 8–9 cm below the level of the inguinal ligament. Its significance in venous return is so great that in the presence of floating thrombi in the femoral vein, resection of the femoral vein below the level of the confluence of the deep femoral vein is acceptable [2]. At the same time, HVB itself can be a source of thrombi [4]. According to classical anatomy, the deep femoral vein is represented by one trunk [5]. However, M.V. Vakhitov et al report that a doubling of the WBG can be observed in 45.3% of cases [6]. R.E. Kalinin et al reported that two trunks of the HVB can occur in 80% of cases, with one of the trunks located on the lateral side of the femoral vein [7]. In addition, there are variants of development with the transition of the popliteal vein and femoral vein to the GVB [8]. At the same time, in the first case, the HVB departs from the popliteal vein and goes more superficially than the adductor great muscle, in the second case, the HVB anastomoses with the femoral vein immediately after exiting the adductor canal, and the femoral vein itself is hypoplastic.

The modern standard for diagnosing the vascular system of the lower extremities is ultrasound duplex angioscanning (USDAS) [9-11]. There is a known method for the study of HVB using duplex scanning in the classical anatomy of the HVB [Patent RU No. 2751819 C1] [12]. With this method, the study is first carried out with the patient lying on his back, and a linear sensor in the upper third of the thigh is placed along the projection line of the femoral vessels, and the mouths of the deep femoral vessels are visualized. Next, a convex sensor is used, in the upper third of the thigh, scanning is carried out along the projection line of the femoral vessels, and in the middle and lower third of the thigh, the sensor is carried out along a line located 2 cm medially to the projection line of the femoral vessels, while the sensor itself deviates posteriorly by 15°. Compression of the veins is performed, the patency of the arteries is assessed. In the position of the patient lying on his stomach, the convex probe is carried out along a vertical line located 3 cm outward from the posterior midline of the thigh.

However, this method does not consider the study of vessels in variant anatomy of the GVB.

EFFECT: determination of the patency and the state of blood flow in the deep vein of the thigh with variant anatomy using UZDAS.

Implementation of the invention

The study of the deep vein of the thigh is carried out in the position of the patient lying on his back. First, a linear transducer is placed along the projection line of the femoral neurovascular bundle in the upper third of the thigh, the place where the deep femoral vein flows into the femoral vein from the lateral side is visualized. Next, the sensor is drawn along a line located at an angle of 90° to the projection line of the femoral neurovascular bundle in the lateral direction (figure 1, 2) to the intersection with the line running from the anterior superior iliac spine to the lateral condyle of the thigh. Next, a convex sensor is used, the scan is carried out along the specified line running from the anterior superior iliac spine to the lateral condyle of the thigh, down (figure 3). Then a linear sensor is used again, which is placed along the projection line of the femoral neurovascular bundle in the upper third of the thigh, the place where the deep femoral vein flows into the femoral vein from the medial side is visualized. Next, a convex sensor is used, scanning is carried out down the projection line of the femoral neurovascular bundle, in the middle and lower third of the thigh, the sensor is carried out along a line located 2 cm medially to the projection line of the femoral neurovascular bundle. In the lower third of the thigh, 4 cm above the medial femoral condyle, the sensor is located at an angle of 120° to the projection line of the femoral neurovascular bundle (Fig. 4, 5). The patency of the deep femoral vein is assessed. Next, the patient turns over on his stomach. In the supine position, a linear sensor is used, which is carried up along the vertical midline located in the popliteal region and on the back of the thigh, to the level of the middle third of the thigh (Fig.6, 7). Proximal to the level of the middle third of the thigh, a convex probe is used, which is carried upwards. The patency of the deep femoral vein is assessed.

Using this method for assessing the state of blood flow in the deep vein of the thigh (500 people), the following were identified:

A) the second stem of the HVB was detected in 396 patients (79.2%);

B) direct anastomosis of the HVB and the popliteal vein was detected in 30 patients (6%);

C) direct anastomosis of the HVB and the femoral vein in 110 patients (22%).

Brief description of the drawings

Fig.2. USDS - scanogram, color Doppler mapping (CDC). Lateral trunk of the HVB.

Fig.5. Ultrasound scan of the anastomosis of the GVB and the femoral vein in the lower third of the thigh.

Fig.7. Ultrasound - scan of the anastomosis of the GVB and popliteal vein, CDI mode.

Fig. 9. Ultrasonography - scan of the variant of the development of the GVB, cross section.

Fig. 10. Ultrasound scan - scan of the variant of the development of the GVB, longitudinal section:

1. Color Flow Mode

2. Spectral Doppler Mode

3. Cross section at the level of the proximal part of the popliteal fossa

4. Longitudinal section at the level of the lower third of the thigh

5. Popliteal artery

6. Popliteal vein

7. Anastomosis of the GVB and popliteal vein

8. Color flow mode at the level of the upper third of the thigh

9. B-mode at the level of the upper third of the thigh

10. B - mode at the level of the middle third of the thigh

11. Superficial femoral artery

12. Femoral vein (hypoplastic)

13. Deep vein of the thigh

14. Color flow mode at the level of the middle third of the thigh

15. Color flow mode at the level of the lower third of the thigh.

Bibliography

1. Russian clinical guidelines for the diagnosis and treatment of chronic venous diseases. // Phlebology. - 2018 - No. 3, volume 12 - 96 p.

2. Asher E. Vascular surgery according to Haimovich in 2 v. T2. Moscow: Binom. Knowledge Lab. 2010; 600.

3. Kovanov V.V., Anikina T.V. Surgical anatomy of human arteries. Moscow: Medicine. 1974.

4. Labropoulos N, Bekelis K, Leon LR Jr. Thrombosis in unusual sites of the lower extremity veins. J. Vasc. Surg. 2008; 47:5:1022–1027.

5. Gaivoronsky I.V. Normal human anatomy T.2. St. Petersburg: SpecLit, 2016. - 564 p.

6. The role of the anatomical factor in the development of primary varicose veins of the lower extremities / M.Sh. Vakhitov, O.P. Bolshakov, S.M. Chekhuta, K.K. Radionov // Regional blood circulation and microcirculation. - 2005. - V. 4 - S.20-24.

7. Kalinin R.E., Suchkov I.A., Klimentova E.A., Shanaev I.N. Clinical anatomy of the deep vessels of the femur in the area of the femoral triangle. Angiology and vascular surgery. 2021;T27(1):17-22.

8. Gilan IY,

Kurtoglu Z. Bilateral persistent sciatic vein: report of a case with developmental, histological and clinical aspects. Surg Radiol Anat 2014; 36:189–194.

8. Gilan IY,

Kurtoglu Z. Bilateral persistent sciatic vein: report of a case with developmental, histological and clinical aspects. Surg Radiol Anat 2014; 36:189-194.

9. Ultrasonic anatomy of the veins of the lower extremities / Mazaishvili K.V. [and others].- M.: Medpraktika. - M., 2016.-72 p.

10. Churikov D.A. Ultrasound diagnosis of venous diseases. / Churikov D.A., Kirienko A.M. // - Litter - 2015. - 176 p.

11. Kulikov V.P. Fundamentals of ultrasound examination of blood vessels. M.: Vidar - M., 2015. - 392 p.

12. Kalinin R.E., Suchkov I.A., Klimentova E.A., Shanaev I.N. A method for examining deep femoral vessels. No. 2751819 C1. 2021.

Claims (1)

A method for examining the deep vein of the thigh in the case of its variant anatomy, including ultrasonic duplex angioscanning, characterized in that the study is first carried out in the position of the patient lying on his back, and the linear sensor is placed along the projection line of the femoral neurovascular bundle in the upper third of the thigh, while visualizing the place of confluence of the deep vein of the thigh into the femoral vein from the lateral side, then the sensor is carried out along a line located at an angle of 90 ° to the projection line of the femoral neurovascular bundle in the lateral direction until it intersects with the line running from the anterior superior iliac spine to the lateral condyle of the thigh, then a convex sensor is used, the scanning is carried out along the indicated line going from the anterior superior iliac spine to the lateral condyle of the thigh, downwards, then the linear sensor is used again, which is placed along the projection line of the femoral neurovascular bundle in the upper third of the thigh, the place of confluence of deep veins is visualized from the thigh into the femoral vein from the medial side, then a convex sensor is used, scanning is carried out down the projection line of the femoral neurovascular bundle, in the middle and lower third of the thigh, the sensor is carried out along a line located 2 cm medially to the projection line of the femoral neurovascular bundle, in the lower third of the thigh, 4 cm above the medial femoral condyle, the sensor is placed at an angle of 120° to the projection line of the femoral neurovascular bundle, the patency of the deep femoral vein is assessed, then a linear sensor is used in the position of the patient lying on his stomach, which is carried up along the vertical midline, located in the popliteal region and on the back of the thigh, to the level of the middle third of the thigh, proximal to the level of the middle third of the thigh, after which a convex probe is used, which is carried upwards, assessing the patency of the deep femoral vein.

Images