股浅静脉第一对瓣膜包窄术治疗原发性下肢深静脉瓣膜功能不全

目的:评估应用股浅静脉第一对瓣膜包窄术治疗原发性下肢深静脉瓣膜功能不全的疗效.方法:对原发性下肢深静脉瓣膜功能不全的55例患才施以股浅静脉第一对瓣膜包窄术,包窄材料选用聚四氟乙烯人造血管.结果:本组病人术后均随访4-14个月,术前临床症状缓争,疗效好,结论:股浅静脉第一对瓣膜包窄术治疗瓣膜轻,中度倒流的原发性下肢深静脉瓣膜功能不全,有坚实的理论基础,并有并发症少,操作简单,疗铲好等优点,值得推广.     

原发性下肢深静脉瓣膜功能不全股静脉形态学研究近况

下肢静脉病是外科的常见病和多发病 ,其中原发性深静脉瓣膜功能不全占有很高的比例[1～ 3 ] ,约 5 3 .0 2 %～ 69% ,其主要的病理特征是 ,在致病因素作用下静脉瓣膜失去单向开放的基本功能 ,静脉扩张、高压 ,久之出现浅静脉曲张、肿胀、皮炎及皮肤营养障碍 ,甚至溃疡形成 ,严重影响患者的生活质量和劳动能力。因此 ,下肢静脉疾病的预防与治疗日益受到重视。本文试就原发性下肢深静脉瓣膜功能不全的形态学研究近况综述如下。一、原发性下肢深静脉瓣膜功能不全的病因及临床表现原发性深静脉瓣膜功能不全是Ｋｉｓｔ ｎｅｒ[4] 在 1980年提出的…     

深筋膜重叠缝合术治疗原发性下肢深静脉瓣功能不全症

原发性下肢深静脉瓣膜功能不全是近几年来一种比较新的概念,由于瓣膜失去功能,血液由上而下,由深向浅倒流,逐渐破坏交通静脉和浅静脉系统,出现了类似大隐静脉曲张的临床表现。原发性下肢深静脉瓣膜功能不全常主要累及股浅静脉第一对瓣膜,目前常用的治疗方法亦主要针对这一点,方法主要包括①股浅静脉瓣膜修复术;②瓣膜移植术;③瓣膜移位术;④股浅静脉带戒术等。以上方法都存在一定局限性。为     

股浅静脉第一对瓣膜环缩术治疗原发性下肢深静脉瓣膜功能不全(附40例报告)

目的 评估应用股浅静脉第一对瓣膜环缩术治疗原发性下肢深静脉瓣膜功能不全的疗效。方法 对原发性下肢深静脉瓣膜功能不全的40例患者(共45条下肢)施以股浅静脉第一对瓣膜环缩术．环缩材料选用7—0或6—0无损伤缝线。结果 经上述治疗后．全组病例术后随访2～24个月．临床症状均明显缓解。彩超复查88．6％(31／35)的患肢瓣膜无返流发生。结论 股浅静脉第一对瓣膜环缩术是治疗原发性下肢深静脉瓣膜功能不全比较理想和有效的方法。     

下肢静脉性溃疡的病因与病理

下肢静脉性溃疡是一种比较常见的外科疾病,其发病率为0.5%～3.0%,是下肢静脉倒流性疾病(如原发性下肢深、浅静脉瓣膜功能不全,下肢交通静脉瓣膜功能不全,先天性下肢深静脉无瓣膜症)及下肢静脉回流障碍性疾病(如下肢深静脉血栓形成[1],下腔静脉阻塞,占位性病变压迫深静脉等)发展     

下肢静脉曲张行浅静脉手术对深静脉瓣膜功能影响的研究

目的：探讨下肢浅静脉手术改善深静脉瓣膜功能的程度及影响效果的因素。方法：收集住院行浅静脉手术治疗的下肢原发性深静脉瓣膜功能不全的患者60例（70条肢体）, 术前经双功能彩色多普勒超声检查记录深静脉血流动力学指标。浅静脉手术后6个月进行随访, 行超声复查, 比较手术前后深静脉瓣膜功能。 结果：下肢浅静脉手术后深静脉瓣膜功能的总体改善率为65.7%；病程超过20年较之病程小于或等于20年的患者改善不佳的可能性高4.355倍；股浅静脉和腘静脉同时存在倒流的患者比两静脉各自单独存在倒流的患者改善不佳的可能性高4.247倍；年龄大于60岁比年龄小于或等于60岁的患者改善不佳的可能性高3.516倍；股浅静脉和腘静脉瓣膜功能改善的程度差异无显著性（P＞0.05）。 结论：下肢静脉曲张单纯行浅静脉手术可在一定程度上改善深静脉瓣膜功能, 手术近期效果好, 可有选择性地应用于某些早期深静脉瓣膜功能不全的患者。     

股浅静脉环包术的手术配合

股浅静脉环包术的手术配合浙江省诸暨市人民医院马秀凤股静脉环包术是治疗下肢原发性深静脉瓣膜功能不全的有效方法之一。我院１９９２年３月至１９９３年１２月，对原发性深静脉瓣膜功能不全的病人施行股浅静脉环包术加大、小隐静脉抽剥结扎术共７４例，随访１年效果良好...     

原发性下肢深静脉瓣膜功能不全手术治疗40例分析

目的探讨原发性下肢深静脉功能不全的手术治疗。方法回顾性分析应用股浅静脉戴戒术治疗原发性下肢深静脉功能不全40例(46条深静脉)临床资料。结果患侧小腿酸胀沉重感均消失或明显改善,6侧肢体溃疡于2～8周内愈合,2侧肢体湿疹样改变脱屑,皮肤变光滑,1侧遗留有足踝部轻度指陷性水肿。28例行股浅静脉彩超检查Valsalva试验见瓣膜反流0级或I级。结论股浅静脉瓣膜戴戒手术时间短,创伤小,是治疗原发性下肢深静脉瓣膜功能不全较为理想和有效的方法。     

下肢慢性静脉功能不全诊断和治疗的再思考

下肢慢性静脉功能不全(chronic venous insuffi-ciencv,CVI)按其病因可分为原发性、继发性、先天性.按其解剖范围可分为浅、深和交通静脉三个系统,亦即包括浅静脉曲张、交通静脉瓣膜功能不全、深静脉瓣膜功能不全和深静脉血栓形成后遗症等[1].     

下肢浅静脉手术后深静脉瓣膜功能变化的中期结果报道

目的观察下肢浅静脉手术改善深静脉瓣膜功能的中期随访结果。方法收集2006年3～10月期间在我院行手术治疗的下肢静脉曲张患者43例(55条肢体),全部患者曾在术后半年进行随访并比较了手术前、后深静脉瓣膜功能改善情况,术后4年再次以同样方法评价其深静脉瓣膜功能改善情况。结果 39例患者深静脉瓣膜功能保持良好,与术后半年随访时无明显差异。4例当时未行高位结扎的患者,再次出现浅静脉曲张,且深静脉存在返流。结论伴有深静脉瓣膜功能不全的下肢浅静脉曲张,单纯行浅静脉激光闭合术或剥脱术均可有效改善深静脉瓣膜功能,且效果保持良好;高位结扎大隐静脉是保证改善深静脉瓣膜功能的关键。     

Central venous versus mixed venous oxygen content

Mixed venous oxygen content (commonly measured as oxygen saturation) is a highly relevant parameter in the monitoring of critically ill patients; unfortunately, its measurement requires catheterization of the pulmonary artery. Though less invasive, the central venous oxygen saturation is an unsatisfactory substitute, due to fluctuations in perfusion distribution and regional oxygen extraction in the course of illness.
The present study examined the relation of oxygen contents in simultaneously withdrawn central venous and mixed venous blood samples from critically ill patients, in order to validate a hypothetical algorithm for the estimation of mixed venous oxygen content from a central venous sample: Although the proposed algorithm had a fairly high power of prediction, its merits in comparison to assuming simple proportionality between central venous and mixed venous oxygen content seemed marginal.
However, as it is likely that the results so far are mathematically coupled, further prospective studies are necessary.     

Diagnosing venous and venous/arterial ulcers

A venous ulcer can be diagnosed on the basis of elements arising from the questioning and the clinical examination of the patient. A venous Doppler ultrasound can specify the type of reverse flow (superficial and/or deep). Measuring the ankle brachial pressure index helps to eliminate or confirm any arterial involvement. Depending on the systolic pressure index, the ulcer will be considered as purely venous, mixed (arterial-venous) or predominantly arterial.     

Management of significant venous discrepancy with microvascular venous coupler

Microsurgery has revolutionized the art of reconstruction, with the discovery of the ability to replace like tissue with like tissue transferred from a distant site. The evolution of the tissue transferred has also progressed. No longer are free flaps based off a dominant anatomically named vessel, but one of its later derivatives, the perforator. Perforator breast reconstruction dominates the authors' practice, and a frequently encountered problem is mismatched vessels. This situation typically requires more time and concentration for successful completion. Venous mismatches tend to be harder to overcome than arterial; the venous hand-sewn end-to-end anastomoses result in bunching of the larger vessel around the perimeter of the smaller. In this low flow system, these anastomotic imperfections can frequently result in anastomotic failure. Many other techniques have also been described in hopes of improving the anastomotic success. These are often timely or lack improvement in patency rates. The authors have found the MCA microvascular venous coupler to be a reliable method to overcome this problem. The end-to-end technique of microvascular coupling allows a perfect intima-to-intima anastomosis despite the variation in caliber of the vessels. The time to complete the end-to-end anastomoses is significantly reduced to only a matter of minutes.     

Deep venous thrombosis and superficial venous reflux

OBJECTIVE: Although superficial venous reflux is an important determinant of post-thrombotic skin changes, the origin of this reflux is unknown. The purpose of this study was to evaluate the frequency and etiologic mechanisms of superficial venous reflux after acute deep venous thrombosis (DVT). METHODS: Patients with a documented acute lower extremity DVT were asked to return for serial venous duplex ultrasound examinations at 1 day, 1 week, 1 month, every 3 months for the first year, and every year thereafter. Reflux in the greater saphenous vein (GSV) and lesser saphenous vein (LSV) was assessed by standing distal pneumatic cuff deflation. RESULTS: Sixty-six patients with a DVT in 69 lower extremities were followed up for a mean of 48 (SD +/- 32) months. Initial thrombosis of the GSV was noted in 15 limbs (21.7%). At 8 years, the cumulative incidence of GSV reflux was 77.1% (SE +/- 0.11) in DVT limbs with GSV involvement, 28.9% (+/- 0.09%) in DVT limbs without GSV thrombosis, and 14.8% (+/- 0.05) in uninvolved contralateral limbs (P <.0001). For LSV reflux, the cumulative incidence in DVT limbs was 23.1% (+/- 0.06%) in comparison with 10% (+/- 0.06%) in uninvolved limbs (P =.06). In comparison with uninvolved contralateral limbs, the relative risk of GSV reflux for DVT limbs with and without GSV thrombosis was 8.7 (P <.001) and 1.4 (P =.5), respectively. The relative risk of LSV reflux in thrombosed extremities compared with uninvolved extremities was 3.2 (P =.07). Despite these observations, the fraction of observed GSV reflux that could be attributable to superficial thrombosis was only 49%. CONCLUSIONS: Superficial venous thrombosis frequently accompanies DVT and is associated with development of superficial reflux in most limbs. However, a substantial proportion of observed reflux is not directly associated with thrombosis and develops at a rate equivalent to that in uninvolved limbs.     

The meaningfulness of central venous blood samples. Central venous versus mixed venous O2 status

Both mixed-venous and "central-venous" oxygen status (O2 partial pressure [pO2], O2 saturation [sO2], O2 concentration [cO2], hemoglobin concentration [cHb]) are often considered to adequately represent total-body oxygen supply. Since modern technology has made continuously in vivo measurement possible, mixed-venous O2 saturation (svO2) and partial O2 saturation (psO2) have become extensively used for that purpose. Both venous sites of measurement are used as diagnostic adjuncts regarding hemodynamic status. However, both are associated with certain problems. There is a lack of any clear definition of a "central-venous" site of the catheter tip (right atrium, superior vena cava, inferior vena cava). Instead, the location of the catheter tip depends upon the approach to the central venous system. One must also be aware of significant migrational tendencies of the catheter tip. Thus, "central-venous" samples can only represent the situation in a single portion of the circulation, whereas the respective organ areas may vary considerably with the same catheter from one time point to another. Furthermore, the state of the coronary circulation never can be evaluated. The frequently postulated correlation of mixed-venous and "central-venous" values decreases with increasing deterioration of the cardiovascular system, especially in patients with high cardiovascular risks. The main overall parameters of mixed-venous oxygen status are oxygen content (cvO2), cardiac output (C.O.), and oxygen consumption (QO2) of the tissues. The relation between arterial and mixed-venous O2 status is given by Fick's principle: caO2-cvO2 = QO2/C.O. From this, it becomes obvious that a relation between cvO2 and C.O. may only be presumed if QO2 and caO2 remain constant. Evaluation of O2 availability (AO2) using cvO2 or the determining components of cvO2 seems reasonable only if the modulating influences of C.O. and QO2 are taken into consideration. Therefore, any empirically deduced relation between svO2 and C.O. (regardless of the origin, i.e., linear or nonlinear) must be viewed as being accidental. This implies that svO2 and cvO2 per se are only partly helpful in evaluating the hemodynamic situation. The best parameters for interpreting the cardiovascular situation seem to be arteriovenous O2 difference (avDO2) and C.O. In particular, the avDO2 can be accepted as an integrating parameter for AO2 and QO2, and may therefore serve as a diagnostic indication of cardiovascular imbalance.     

Relationship of venous reflux to the site of venous valvular incompetence: implications for venous reconstructive surgery

To evaluate the relationship of the site of venous valvular incompetence to the severity of venous reflux, legs of 71 patients with suspected chronic venous insufficiency were evaluated with Doppler ultrasonography and photoplethysmography. A venous recovery time (VRT) of less than 20 seconds after calf muscle exercise was considered indicative of significant reflux. Average VRTs were brief in 15 legs with stasis changes (10 +/- 7 seconds), longer in 42 legs with edema (26 +/- 23 seconds), and normal in 64 asymptomatic legs (37 +/- 24 seconds) and 16 legs with pain (53 +/- 19 seconds). Average VRTs in limbs with incompetent saphenous veins were abnormal. In limbs with competent superficial veins, only those with incompetent distal deep veins (popliteal and posterior tibial) had abnormal VRTs (14 +/- 10 seconds). VRTs in limbs with no detectable valvular incompetence and in those with incompetence limited to the proximal deep veins (common and superficial femoral) were normal (47 +/- 23 and 42 +/- 27 seconds, respectively). When superficial veins were incompetent, an ankle tourniquet normalized VRTs in 63% of legs with proximal deep venous incompetence and in only 33% of legs with distal deep venous incompetence. It is concluded that venous reflux is largely determined by saphenous and distal deep valvular function and that competence of the proximal valves has little effect. Decreased venous reflux would not be expected after proximal valvular reconstruction.     

Compression and venous surgery for venous leg ulcers

This article reviews published data on the effects of surgery and compression in the treatment of venous ulcers and the best options for compression therapy. Randomized controlled studies reveal that surgery and compression have similar effectiveness in healing ulcers but surgery is more effective in preventing recurrence. Most leg ulcers have a venous pathophysiology and occur because of venous ambulatory hypertension caused by venous reflux and impairment of the venous pumping function. Proposed surgical interventions range from crossectomy and stripping to perforator vein interruption and endovascular procedures (laser, radiofrequency). More conservative procedures (foam sclerotherapy, conservative hemodynamic treatment) have also been proposed.     

Clinico-histopathological correlations of venous wall modifications in chronic venous insufficiency

The interest manifested for the conjunctive tissue pathology leaded to the study of the structural disorder that appears in the varicose veins walls. The study is a prospective one initiated in March 2007 made on 11 patients with varicose disease hospitalized at Cluj-Napoca within Surgery Clinic no. II. The purpose of this study is to point out the histopathological modifications in the varicose venous wall (great saphenous vein cross, communicating veins, perforating veins), as well as the correlation of histopathological results with the evolutive stage of chronic vein insufficiency (CEAP classification) and with the clinical score at these patients. The histopathological (HP) results for 2 of the patients revealed hypertrophy of the media, intimal hyperplasia (stage II) corresponding to a CEAP 3. Six patients were integrated in HP stage III due to the partial intimal fibrosis corresponding to a CEAP 6 for one case, CEAP 4 one case, CEAP 3 four cases. One patient had HP stage I with CEAP 3 and two patients had HP stage IV corresponding to CEAP 5, respectively CEAP 6.     

Ultrasonographic assessment of ambulatory venous pressure in superficial venous incompetence

Purpose: In spite of its invasiveness, measurement of ambulatory venous pressure (AVP) is widely considered the gold standard measurement of venous function. We studied a technique for noninvasive ultrasonographic AVP determination in superficial venous incompetence.Methods: A linear relationship between venous pressure (measured by echo-guided venous puncture) and diameter (measured by transverse axis duplex imaging) was preliminarily demonstrated with multiple measurements in different conditions (supine, sitting, standing, and Trendelenburg positions, after exercise with and without cuff occlusion) in a saphenous tract at the thigh of 82 limbs in which reflux had been previously demonstrated. Then AVP was measured in another group of 44 patients who had demonstrated superficial venous incompetence, both with and without proximal occlusion, using again the same invasive method and a new noninvasive technique. The latter technique consisted in the construction of a linear diameter/pressure curve obtained after saphenous diameter (by high-resolution sonography) and noninvasive pressure (using hydrostatic values) determinations in the sitting and standing positions. Further measurement of saphenous diameter after standardized exercise permits extrapolation of the AVP values from the curve.Results: Linear regression analysis demonstrates that (1) beginning from 20 mm Hg, the pressure/diameter relationship of the incompetent greater saphenous vein is linear; and (2) AVP values derived invasively and noninvasively are significantly correlated (r = 0.7347 and p < 0.0001 for AVP derived without occlusion; r = 0.7270 and p < 0.0001 for values recorded with occlusion).Conclusions: The proposed technique appears able to reliably assess noninvasively AVP values in superficial venous incompetence. In addition, it can be performed with equipment that is widely used for vascular investigations. (J Vasc Surg 1997;26:796-802.)