Cockett综合征

又称为May—Thurner综合征或骼总静脉压迫综合征，为右侧髂总动脉压迫左侧髂总静脉所致，形成的原因不明。1965年Cockett和Thomas报告2例患者，首次命名为“髂静脉压迫综合征”。随着解剖学研究和临床报告增多，发现除左髂总静脉受压最多外，还有其它受压类型，以及盆腔病变也能引起Cockett征。所以又出现了May—Thurner综合征、髂腔静脉压迫综合征、盆腔静脉压迫综合征，以及先天和后天髂静脉压迫综合征等名称，但仍以髂静脉压迫综合征多用。许多学者认为统称Cockett综合征合适。     

青春期髂静脉综合征25例报告

髂静脉综合征（ICS）是指左髂总静脉汇人下腔静脉处受到右髂总动脉压迫，引起左下肢静脉回流受阻、静脉压升高而产生的一系列症状。我院于2000年6月至2005年6月期间收治单纯青春期ICS25例。报道如下。     

NCE-MRA在评价髂静脉受压分型中的应用价值

目的 探讨盆腔无对比剂增强的磁共振血管成像（NCE-MRA）在评价髂静脉受压分型中的应用价值。方法 收集2020年5月至2021年9月在重庆医科大学附属第一医院行盆腔NCE-MRA检查的126例患者临床资料,通过多平面重组及容积再现技术分析髂静脉压迫的特征。结果 126例患者共244处受压部位,最常见的髂静脉受压部位为左髂总静脉（77.46%）,其中左髂总静脉与腔静脉交界处受压患者比例为47.13%。根据髂静脉受压部位的特征确定了4种压迫类型,Ⅰ型为左髂总静脉与腔静脉交界处受压（30.16%）,Ⅱ型为左髂总静脉与腔静脉交界处和左髂总静脉两处受压（27.78%）,Ⅲ型为左髂总静脉与腔静脉交界处、左髂总静脉和右髂总静脉三处受压（17.46%）,Ⅳ型为其他类型（24.60%）。结论 NCE-MRA有助于对髂静脉根据受压部位进行分型,4种分型的建议可能有助于临床医师预测髂静脉压迫综合征患者是否受益于腔内介入治疗。     

髂静脉受压综合征的支架治疗

正髂静脉受压综合征(iliac vein compression syndrome,IVCS)泛指在盆腔内的髂静脉受邻近组织压迫(主要指左髂总静脉在右髂总动脉和第五腰椎之间受压),持续的压迫及动脉搏动引起静脉内膜增生和纤维化,导致静脉管腔狭窄或闭塞,从而造成静脉回流受阻、静脉高压及下肢慢性静脉功能不全(chronic venous insufficiency,CVI),并由此     

左髂总静脉受压处和静脉内粘连结构的组织学研究

目的　探讨左髂总静脉受压处的组织学变化和静脉内粘连结构形成的原因。方法　利用Van Gieson染色、Verhouff染色及苏木素 伊红 (HE)染色方法 ,在光镜下对 11例受压左髂总静脉及静脉内粘连结构的组织学特点进行观察和测量。结果　静脉内粘连结构内平滑肌含量 4.7% ,比正常对照组减少 (P <0 .0 1) ,胶原纤维含量 2 8.4% ,比正常对照组增多 (P <0 .0 5 ) ;粘连结构与血管壁交界处平滑肌含量增多 (11.6% ) ,P <0 .0 5 ;受压左髂总静脉前壁、后壁和粘连结构与血管壁交界处的内膜增厚 (分别是 76.5、78.7和 2 65 .2 μm ) ,分别为P <0 .0 5、P <0 .0 5和P <0 .0 1;左髂总静脉前壁全层变薄 (2 2 3 .3 μm) ,P <0 .0 1,粘连结构与血管壁交界处全层增厚 (1182 .6μm ) ,P <0 .0 1。结论　静脉内粘连结构是后天形成的 ,是由于静脉长时间受压刺激后发生内膜过度增生和纤维化的结果 ,平滑肌的增殖和迁移起着重要作用。     

髂静脉压迫综合征的诊断及治疗研究进展

髂静脉压迫综合征( iliac vein compressionsyndrome,IVCS)又称May-Thurner综合征或Cockett综合征,是由于髂静脉受压导致的下肢和盆腔静脉回流障碍性疾病,好发于中青年女性,其中20~40岁女性患者占全部IVCS 患者的60%~85%[1],临床表现包括下肢疼痛、静脉曲张、色素沉着、水肿、溃疡、跛行等。髂静脉的解剖位置是导致疾病发生的主要因素,左髂总静脉主要从右髂总动脉和L5之间穿过,受到长期的机械性压迫和髂动脉的搏动性刺激2],故临床上以左髂总静脉受压最常见。     

髂静脉受压综合征的研究近况

髂静脉受压综合征（IVCS）主要由于右髂总动脉与第五腰椎同压迫左髂总静脉而引起的左下肢静脉回流障碍的症候群。绝大多数IVCS患者临床症状不明显,但有症状的多为年轻人并影响其生活质量。常因为慢性静脉功能不全而表现出下肢静脉曲张、肿胀及静脉性间歇性跛行,也可因为急性髂股静脉血栓形成导致股青肿。此征诊断主要依靠静脉造影、磁共振、CT及腔内血管超声等。传统的治疗方式创伤大、效果差。而应用腔内血管重建术治疗此征能取得极佳疗效。将近几年来对此征的研究进展作一综述。     

非血栓性髂静脉压迫性病变的诊治进展

非血栓性髂静脉压迫性病变(nonthrombotic iliac venous compression syndrome,NIVCL)是指髂静脉受到前方髂动脉及后方腰椎压迫而导致髂静脉病理结构及血流动力学改变,引起临床一系列症状群的总称。1957年,May和Thurner尸检研究提出:右髂总动脉横跨在左髂总静脉前方,长期反复搏动对髂静脉管壁造成慢性刺激,进而引起静脉腔内结构改变,静脉壁内膜增厚并继发静脉阻塞[1]。既往人     

髂静脉压迫综合征的介入治疗

McMurrich最早发现左下肢肿胀继发于左髂静脉受压，迄今已近百年。May等和Cockett等分别于1957年和1965年对此进行解剖和临床描述，南此髂静脉压迫综合征又称为Cockett综合征：临床主要表现为左下肢肿胀、浅静脉曲张．严重者可产生经久不愈的小腿溃疡及静脉性跛行，且易继发深静脉血栓．1999年4月至2003年6月，我们采用介入方法(球囊扩张和支架植入)治疗髂静脉压迫综合征病人12例。现报道如下。     

左下肢静脉功能不全患者左髂总静脉受压程度与压迫类型及血栓形成的关系

目的探讨左下肢静脉功能不全患者左髂总静脉受压程度、压迫类型及血栓形成之间的关系。方法对258例左下肢静脉功能不全患者行下肢CTV检查,观察左髂总静脉受压程度、压迫类型、有无左髂静脉血栓,并分析其间的关系。结果 258例中,84例存在左髂静脉血栓;左髂总静脉受压程度为(54.12±32.73)%;压迫类型为高位型5例,交界型241例,低位型12例。左髂总静脉受压程度50%与≥50%患者之间,压迫类型差异有统计学意义(P0.05);有无左髂总静脉血栓患者之间,左髂总静脉受压程度差异有统计学意义(P0.001)。结论左下肢静脉功能不全患者左髂总静脉压迫类型以交界型为主,受压程度≥50%可促进血栓形成。     

Venous reconstruction of the inferior vena cava bifurcation for retroperitoneal rhabdomyosarcoma in a child. Case report

Retroperitoneal tumors, as well as traumatic lesions and occlusions of the bifurcation of the inferior vena cava (IVC) and the common iliac veins may require venous vascular reconstruction. We present a method for inferior vena caval bifurcation reconstruction which employs the advantages of a large size straight expanded polytetrafluorethylene (ePTFE) graft in this position after a new IVC bifurcation has been created by uniting the stumps of both common iliac veins, and construction of an arteriovenous (A-V) fistula with controlled flow to decrease the rethrombosis rate of the graft, and still not cause heart failure. This method was used in a case of recurrent rhabdomyosarcoma in an 8 year old child encroaching upon the bifurcation of the IVC as well as on both common iliac veins. The situation was managed by radical resection of the tumor and by creating a new caval bifurcation of the common iliac veins, followed by interposition of a straight ePTFE graft. An A-V fistula was created between the left femoral vein and left femoral artery using the left greater saphenous vein in controlled fashion. The arterial defect of the right common iliac artery was reconstructed by interposition of a PTFE graft end-to-end.     

Giant hydronephrosis presenting as unilateral iliofemoral vein thrombosis

We report a case of left iliofemoral vein thrombosis with extension to the inferior vena cava associated with giant right hydronephrosis secondary to ureteropelvic junction obstruction. Surgery revealed marked infrarenal vena caval compression and deviation to the left side caused by the dilated right renal pelvis, with resultant kinking of the origin of the left iliac vein. It is postulated that the reduction in blood flow caused by this compression and distortion predisposed this patient to venous thrombosis.     

Secondary rupture of an iliac artery aneurysm after exclusion-bypass

We report a case of secondary rupture of a common iliac artery aneurysm into the common iliac vein. Exclusion of the iliac aneurysm had been performed 2 years earlier in association with reconstruction of an aortic aneurysm that had ruptured into the inferior vena cava. After closure of the aortocaval fistula by the endoaneurysmal route, aortobifemoral bypass grafting had been performed and a caval clip had been placed. The common iliac arteries had been sutured by the endoaneurysmal route and the right common iliac artery had been excluded by ligation of the right iliac artery. Occlusion of the inferior vena cava distal to the caval clip resulted in increased peripheral venous hypertension causing the secondary arteriovenous fistula (rupture of scrotal varices and edema of lower extremities) but prevented right cardiac insufficiency. This observation confirms the possibility of secondary rupture after treatment of an aneurysm by exclusion. Thus the inclusion-graft technique is more reliable.     

Placement of two Greenfield filters in a duplicated vena cava

Congenital anomalies of the inferior vena cava (IVC) are not unusual and may complicate the placement of caval interruption devices. A duplicated IVC was demonstrated by venography in a patient with left iliofemoral venous thrombosis. A Greenfield filter was placed in each cavum from a right internal jugular vein approach. Because anomalies of the IVC are common, ascending venograms should be obtained in all patients who undergo caval interruption to document the number and position of the IVC, the location of the caval bifurcation, and the diameter of the IVC, as well as to identify the presence of thrombus within the lumen of the IVC. Unrecognized anomalies of the IVC may contribute to the incidence of recurrent pulmonary embolus after Greenfield filter placement.     

Occlusion of left common iliac vein by a distended urinary bladder in a male with paraplegia due to spinal cord injury

STUDY DESIGN: A report of a male subject who sustained paraplegia at T-5 level due to spinal cord injury (SCI) 18 years ago, and in whom, occlusion of the left common iliac vein by a distended bladder was detected during a routine follow-up. OBJECTIVES: To illustrate a rare complication of chronic distension of the urinary bladder viz occlusion of the left common iliac vein, which persisted even after providing adequate bladder drainage by intermittent catheterisation. SETTING: Regional Spinal Injuries Centre, Southport, UK. METHODS: As part of a routine follow-up, we performed intravenous urography by injecting 50 ml of Ultravist 300 in a vein over the dorsum of the left foot. Opacification of collateral veins in the pelvis was seen in the 5- and 10-min films, which suggested iliac venous occlusion. In order to confirm the diagnosis, contrast was injected intravenously in the left foot and venography was performed. RESULTS: Venography revealed a distended left common iliac vein with contrast flowing into the right internal iliac vein through collateral veins in the pelvis; the right common iliac vein and inferior vena cava were patent. Duplex Doppler sonography showed compression of left common iliac vein by the posterior wall of a distended bladder with absence of blood flow through the compressed segment. Computerised tomography (CT) confirmed the diagnosis of extrinsic compression of the left common iliac vein against the promontory of sacrum by a distended bladder. CT excluded other causes for iliac vein occlusion. CONCLUSION: In a male subject with SCI, chronic bladder distension produced occlusion of the left common iliac vein. Health professionals caring for individuals with SCI should be aware that long-standing bladder distension could cause pressure effects upon adjacent structures in the pelvis.     

Replacement of the retrohepatic vena cava in segmental liver transplantation

Reduced grafts represent an important technical development in paediatric liver transplantation. The use of a left lateral segment graft has required preservation of the native inferior vena cava to “piggy-back” the graft onto it. We report four children who underwent left lateral segment transplantation with caval replacement using the donor iliac vein because the native retrohepatic inferior vena cava was small, friable or difficult to preserve. There were no caval or hepatic vein complications post-transplant and the donor iliac vein proved to be a satisfactory interpositional graft. The technique offers the advantages of a wider retrohepatic cava avoiding venous outflow or caval obstruction, provides good tissue to suture and is well suited for the triangulation technique of the left hepatic vein. Received: 24 January 1997 Received after revision: 20 June 1997 Accepted: 30 June 1997     

Unusual case of right-sided May-Thurner syndrome and review of its management

May-Thurner syndrome is a phenomenon commonly described as an acquired stenosis of the left common iliac vein as a result of right common iliac artery compression. We report an unusual case of right-sided May-Thurner syndrome in a patient found to have a left-sided inferior vena cava. We also review the management of this patient using angioplasty, intraoperative thrombolysis, and endoluminal stent placement.