Lower extremity swelling and weakness

Introduction Swelling and fatigue of the lower extremities is one of the symptoms of deep vein thrombosis. Mostly caused by cervical spondylotic myelopathy, manifested as lower limb weakness, numbness, tightness, heavy feelings such as heavy lifting, and gradually appear limp, trembling, gait shaking, easy to fall and so on.

Cause

After the iliac vein was compressed, the vein wall of the compression section was edematous, and the wall thickening was grayish white. The endothelial cells of the severely long-term compression tube wall disappeared, replaced by collagen fibers and connective tissue, and adhesions formed in the lumen. The adhesion structure has a triangular shape, a rectangular shape, a transverse shape and a strip shape. If the adhesion is extensive, the blood flow resistance increases, the blood flow is slow, and a thrombus may form, resulting in occlusion of the lumen, and the appearance is a flat strip. Severe venous compression or adhesion, resulting in lumen shrinkage, venous return disorder, venous pressure increased. Elevated venous pressure can cause symptoms such as swelling of the lower extremities and superficial varices. After the venous return is blocked, a collateral circulation is gradually established. The most common is the pelvic vein and the left lumbar ascending vein. These collateral veins are important compensatory effects when the common iliac vein is blocked.

an examination

Related inspection

Ultrasound examination of the kidney

Clinical manifestations and classification

Cockett syndrome occurs in young adults, and is more common in 20 to 40 years old. Continued lower extremity swelling and fatigue are the most common early manifestations of this disease. Female patients may be accompanied by menstrual extension and increased menstrual flow, as well as swelling of the lower limbs during menstruation. As the symptoms worsen, there will be shallow varicose veins of the lower extremities, which can cover a wide range of the lower abdomen wall, and the degree of varicose is heavy, which can form ulcers that have not healed for a long time.

At present, the disease is divided into six types according to the way the arteries compress the veins:

Type I: the right common iliac artery oppresses the left common iliac vein;

Type II: the right common iliac artery is compressed at the distal end of the inferior vena cava;

Type III: right common iliac artery oppresses the right external iliac vein;

Type IV: compression of the left external iliac vein at the inguinal ligament;

V type: the left internal iliac artery oppresses the left common iliac vein;

Type VI: The left common iliac vein was compressed by the left internal iliac artery.

[Auxiliary inspection]

1. Ultrasound examination: a simple, non-invasive diagnosis method, which can be checked repeatedly if necessary. However, the accuracy of the compression of the iliac vein is slightly worse.

2, venography: is the main method of diagnosis of this disease. Transfemoral angiography is superior to antegrade angiography of the lower extremities. The main signs are: widening of the transverse diameter of the compressed segment, limited filling defect, venous occlusion, venous angle of the compressed segment, formation of collateral circulation, delay of contrast agent emptying, etc.

3. Intravenous pressure measurement: The venous pressure will increase after the iliac vein is compressed. If the pressure difference between the two ends of the pressure segment is greater than 1.5mmHg, it indicates that treatment is needed.

diagnosis

Those with the following characteristics can diagnose the Cockett syndrome:

1, more common in young and middle-aged patients.

2, continued swelling and fatigue of the lower limbs.

3, as the symptoms worsen, there will be severe lower extremity superficial varices.

4, Doppler ultrasound is helpful for diagnosis, venography can confirm the diagnosis.

Differential diagnosis

Differential diagnosis of lower extremity swelling and fatigue:

1, lower extremity muscle spasm: lower extremity muscle spasm is a symptom of spinal cord compression.

2, lower limb weakness: lower limb weakness is caused by cervical spondylotic myelopathy, manifested as lower limb weakness, numbness, tightness, heavy lifting and other symptoms, gradually appearing limp, trembling, gait shaking, easy to fall, etc. . Cervical spondylotic myelopathy is a type of cervical spondylosis. Cervical spondylosis can be roughly divided into four types: cervical cervical spondylosis, radiculous cervical spondylosis, vertebral artery type cervical spondylosis, and cervical spondylotic myelopathy. Cervical spondylosis, also known as cervical vertebra syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, and cervical disc herniation. It is a disease based on degenerative pathological changes.

Mainly due to long-term cervical vertebrae strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical syndromes of dysfunction. The manifestations of cervical disc degeneration and its secondary pathological changes, such as vertebral instability, loosening; nucleus protruding or prolapse; spur formation; ligament hypertrophy and secondary spinal stenosis, etc., stimulated or oppressed Adjacent nerve roots, spinal cord, vertebral artery, and cervical sympathetic nerves, and cause a variety of symptoms and signs of the syndrome.

3. Diffuse edema of the lower extremity: diffuse edema of the lower extremity means that the edema starts from the lower extremity and is diffuse.

4, lower extremity or soft body of the whole body: lower limbs or soft palate in the whole body is a symptom of the water and salt metabolism disorder in Barth Syndrome.

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