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The venous pattern in femoral head necrosis. Digital subtraction angiography and phlebography in 5 patients
1Department of Orthopedics, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands.
Insights
Idiopathic ischemic necrosis of the femur head may involve venous obstruction, not arterial issues. This venous stasis might stem from arteriovenous-venous shunting, potentially linked to sympathetic dysfunction.
Area of Science:
- Orthopedic Surgery
- Vascular Imaging
- Pathophysiology
Background:
- Idiopathic ischemic necrosis of the femoral head is a debilitating condition.
- Previous studies focused on arterial supply, but venous circulation remains less understood.
- Understanding the vascular dynamics is crucial for effective treatment.
Purpose of the Study:
- To investigate the venous circulation in idiopathic ischemic necrosis of the femoral head.
- To explore potential causes of venous obstruction in these cases.
- To correlate findings with sympathetic nervous system function.
Main Methods:
- Digital subtraction angiography was performed in 5 patients.
- Pertrochanteric phlebography was utilized to assess venous drainage.
- Arterial and venous phases were analyzed for abnormalities.
Main Results:
- Digital subtraction angiography revealed normal arterial and venous circulation.
- Pertrochanteric phlebography demonstrated contrast stasis, indicating venous obstruction.
- Findings suggest a potential role for venous compromise in femoral head necrosis.
Conclusions:
- Venous obstruction, rather than arterial insufficiency, may be implicated in idiopathic ischemic necrosis of the femoral head.
- Arteriovenous-venous shunting secondary to sympathetic dysfunction is a plausible mechanism.
- Further research is warranted to confirm these vascular findings and their clinical implications.
Abstract:
According to digital subtraction angiography in 5 cases of idiopathic ischemic necrosis of the head of the femur, the arterial and venous circulation was normal. However, pertrochanteric phlebography showed stasis of contrast indicating venous obstruction. We suggest that this could be due to arteriovenous-venous shunting, possibly resulting from sympathetic dysfunction, as in the diabetic foot.