齊藤 雪枝¹, 根本 寛子²

Yukie SAITO¹, Hiroko NEMOTO²

¹国家公務員共済組合連合会横浜南共済病院臨床検査科, ²横浜市立大学大学院医学研究科外科治療学教室

¹Department of Clinical Laboratory，Yokohama Minami Kyousai Hospital, ²Department of Surgery, Graduate School of Medicine, Yokohama City University

キーワード : varicose veins, tibial bone, perforating vein incompetence

下肢静脈瘤は静脈弁の機能不全により静脈が拡張する疾患で．伏在型や側枝型などが一般的であるが， 脛骨小孔部の穿通枝を由来とする極めて稀な静脈瘤を3例経験したので報告する．1例目は60歳代女性．左下肢静脈瘤（C1）の精査目的に来院した．2例目は50歳代男性．両側下肢浮腫，両側下肢静脈瘤（C4a），うっ滞性皮膚炎の精査目的に来院した．3例目は60歳代男性．左下肢浮腫，静脈拡張（C4a）の精査目的に来院した．超音波検査において，3例全てに共通して患側の脛骨前面に小孔を認め，小孔部を覆う拡張血管が描写された．ミルキング操作を用いたカラーフローとパルスドプラ法では脛骨内部から小孔を介して骨外へ流出する静脈血流が認められ，脛骨穿通枝由来の下肢静脈瘤と診断した．脛骨穿通枝由来の静脈瘤に対しては，超音波検査が原因静脈を特定できる唯一の検査であった．

In varicose veins in the lower extremities, the veins dilate due to venous valve dysfunction and are generally saphenous or the lateral branch type. We report three very rare cases of varicose veins originating from a tibial perforator. The first case is a woman in her 60s. She visited our hospital with a varicose vein (C1) in her left lower extremity. The second case is a man in his 50s. He visited our hospital with bilateral lower limb edema and bilateral varicose veins (C4a). The third case is a man in his 60s. He visited our hospital with left lower extremity edema and venous dilatation (C4a). Ultrasonography revealed a small hole on the anterior surface of the tibia on the affected side, which was common to all three cases, and a dilated blood vessel covering the small hole was depicted. On color flow imaging using milking and on pulse Doppler, venous blood flow from the inside of the tibia to the outside of the bone through a small hole was observed. The diagnosis was varicose veins of the lower extremities derived from a perforator of the tibia. For varicose veins derived from an incompetent tibial perforator, ultrasonography was the only examination that could identify the causative vein.