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The signs and symptoms of NCS are all derived from the outflow obstruction of the left renal vein. The compression causes renal vein hypertension, leading to hematuria (which can lead to anemia) [4] and abdominal pain (classically left flank or pelvic pain). [5] The abdominal pain may improve or worsen depending on positioning. [5]
Degree of bulging of the femoral head-neck junction: In normal conditions there is a symmetric concave contour at the junction of the femoral head and neck. Loss of this concavity or bone bulging may lead to cam type impingement. The degree of this deformity can be measured by the alpha angle.
Being protected between two fasciae, the superficial veins belonging to compartment N3 very rarely become sinuous. Thus, when a sinuous vein is detected, the sonographer will suspect that it is a tributary. The sapheno-femoral junction is tested by the Valsalva maneuver, with the use of color Doppler being helpful at this stage. [35]
It is coated with cartilage in the fresh state, except over an ovoid depression, the fovea capitis, which is situated a little below and behind the center of the femoral head, and gives attachment to the ligament of head of femur. The thickest region of the articular cartilage is at the centre of the femoral head, measuring up to 2.8 mm. [1]
The neck is flattened from before backward, contracted in the middle, and broader laterally than medially. The vertical diameter of the lateral half is increased by the obliquity of the lower edge, which slopes downward to join the body at the level of the lesser trochanter , so that it measures one-third more than the antero-posterior diameter.
The sapheno-femoral junction (SFJ) is located at the saphenous opening within the groin and formed by the meeting of the great saphenous vein (GSV), common femoral vein and the superficial inguinal veins (confluens venosus subinguinalis).
It passes through the angle formed by the abdominal aorta (situated posteriorly), and superior mesenteric artery (situated anteriorly) (increased acuteness of this angle may lead to the left renal vein being "pinched" between the two arteries, with the resulting compression impairng blood flow through the vein, a condition known as nutcracker ...
The great saphenous vein is exposed and the common femoral and subsartorial veins are identified before dividing. The vein is ligated close to the junction with of the femoral vein. [ 3 ] If the ligation is distal from the saphenofemoral junction , it will leave out small tributaries which may later cause recurrence of varicosities.