足背深浅静脉交通支的瓣膜朝向与皮瓣移植的关系

解剖研究了30例成人下肢标本的足背浅静脉与深静脉间的交通支,重点观察了这些交通支内瓣膜存缺情况及其朝向。这些交通支的静脉瓣可以分为三类:第一型的静脉瓣膜朝向引导血流由浅入深,第二型则引导血流由深至浅,第三型静脉交通支内没有瓣膜。足背皮瓣移植术中,沟通深浅两套静脉系统的关键性交通支是浅弓支。浅弓支属第三型,其出现率占70%,这是大多数足背皮瓣移植时只吻合浅静脉或深静脉均能引导血液回流,保证皮瓣成活的解剖学基础。但对30%缺乏浅弓支的个体,手术时必须同时吻合浅深两套静脉,才能保证回流通畅。     

联合超声技术诊断上肢深静脉血栓形成

目的　探讨上肢深静脉血栓 (UEDVT)的声像特征及超声诊断UEDVT的临床价值 .方法　对 3 8例单侧上肢临床疑UEDVT的患者进行超声检查 ,包括二维加压超声、彩色血流多普勒显像 (CFDI)、二维血流显像 (B -flow)及脉冲多普勒技术 (PWD)的综合使用 .结果　 2 6例经检查确诊UEDVT ,其中 4例合并有浅静脉血栓 . 11例正常 ,1例为胸廓出口综合征 .完全栓塞 42条 ,不完全栓塞 2 1条 .结论　加压超声结合CDFI及 /或B -flow对确定静脉血栓部位、静脉阻塞情况的判断有可靠的价值 ,为诊断UEDVT的首选方法 ,PWD对判断血流状态有帮助 ,但对判断血栓的存在不是必须的     

布-加综合征的彩色多普勒超声诊断及与肝硬化的鉴别诊断

目的探讨彩色多普勒超声在诊断布-加综合征及与肝硬化的鉴别诊断中的应用价值。方法32例布-加综合征患者（男性19例,女性13例,平均年龄37岁）和40例门脉性肝硬化患者（男性28例,女性12例,平均年龄48岁）,分别接受二维超声、彩色多普勒超声和频谱多普勒超声检查,并对获得的资料进行回顾性分析。所有患者经血管造影和/或病理、CT证实。结果布-加综合征的典型特征是病变主要累及下腔静脉和肝静脉,病变处管腔闭塞或狭窄,其内血流紊乱,并可出现侧支循环和交通支;肝硬化患者主要表现为肝脏缩小、脾大、门静脉增宽、腹水,血流动力学改变主要以门静脉和肝静脉为主。结论彩色多普勒超声对布-加综合征、肝硬化的诊断及鉴别诊断符合率较高,为诊断布-加综合征和肝硬化提供有效手段,对选择合理治疗方案及评价治疗效果具有指导意义。     

Anatomical study of distribution of valves of the cutaneous veins of adult''s limbs

Since the cutaneous veins of the four limbs have been used as autogenous grafts in the treatment of cardiovascular disorders, knowledge of distribution of the valves is increasingly required depending upon the use. In the gross anatomical study of distribution of valves of the trunci venae, there has been argument about locational relationships between the venous roots and the valves in the vicinity of the roots and the inter-valvular distance. However, there have been only few reports discussing detailed information about valves of the cutaneous veins of the four limbs. The authors observed patterns of distribution of the cutaneous venous valves of the four limbs of cadavers prepared for practice in anatomy. The following parts were excised from each cadaver: the cephalic, basilic, and the great saphenous veins, which originate from the acral venous network and flow into the proximal deep veins, and the venous roots communicating with these veins. An incision was made on each excised vein in the direction of the long axis under observation with a stereoscopic microscope, and the inter-valvular distance and the distance between the valve and the orifice of venous root in the vicinity of the valve were measured. The inter-valvular distance varied with type of the truncus venae, and it varied according to area even in the same truncus venae.     

Pulmonary venous changes in chronic hypoxia

Summary Lung tissue from 14 normal residents of high altitude regions, 10 patients with chronic bronchitis and emphysema, and 1 patient with Pickwickian syndrome was studied with regard to the occurrence of pulmonary vascular changes. In addition to the well-known pulmonary arterial alterations, lesions in small pulmonary veins were found in the great majority of the cases. These changes, consisting of medial hypertrophy and arterialization and of bundles of smooth muscle cells within the venous intima, have not been described before in man. These findings suggest that alveolar hypoxia acts not only on small pulmonary arteries and arterioles but also on veins of small caliber, probably by inducing venoconstriction.     

Morphological changes in femoral vein wall structure in presence of persistent vertical reflux

The article contains an analysis of different mechanisms of persistent chronic venous insufficiency formation and its impact on the condition of lower extremity magistral vein wall. The authors studied autopsy samples of femoral vein segments from 86 patients aged 56 to 64 years, who had died of non-cardiovascular diseases. The investigation revealed significant changes in the vein wall structure, associated with persistent overload caused by valvular insufficiency and continuous persistent vertical reflux. At the same time, valve cusp structure remodels. Histological studies show that the overload of the system of deep femoral vein segment primarily increases the bulk of longitudinal smooth muscle cells, which fulfill the main contractile function in contrast to circular smooth muscle cells, performing the tonic function. Further overload of all vein wall structures results in structural alterations, smooth muscle cell hypertrophy, forming of longitudinal smooth muscle cell fascicle, and finally, their dystrophic changes. These processes bring about clinical presentations of chronic venous insufficiency.     

Venoocclusive disease of the liver and phlebectatic peliosis in the golden hamster exposed to dimethylnitrosamine

The liver of Syrian hamsters was studied after exposure to dimethylnitrosamine (DMN) in drinking water for, respectively, 8, 12 and 16 weeks. One additional group of animals was offered DMN for 8 weeks, but maintained for further 8 weeks after removal of the compound. The changes consisted of a narrowing portal venopathy, probably arising, initially, from toxic pylephlebitis, being followed by widespread subendothelial prolapse of hepatocytes encroaching upon the lumen of terminal hepatic veins, which generally were free of inflammatory fibrosing lesions. The venous lesions were unrelated to malignant processes in the biliary duct system, which occurred after 16 weeks. Dilatation of sinusoids and small venules was associated with the presence of prolapsed hepatocytes around their openings into involved larger veins. At the end of 12 and 16 weeks of continuous ingestion of DMN, but also where the agent was withdrawn already at 8 weeks, phlebectasis and transitional stages in the formation of teleangiactatic type of peliosis were demonstrated, probably resulting from progressively impeded blood flow due to partial occlusion by prolapsed hepatocytes in terminal veins. The mechanism enabling hepatocytes to penetrate the venous wall was not clarified. There was no indication of invasive malignancy. Hepatocyte prolapse appeared more likely to result from some unknown mechanism of benign infiltration, promoted by regenerative stimulation. This may have been initiated by mild persistent ischemia due to the demonstrated portal venopathy. No endothelial hyperplasia was seen at any stage of the experiments thus eliminating the probability of peliosis being a source of vascular neoplasia, which has previously been described following more prolonged exposure to DMN. Certain parallelisms of the experimental results with hepatic vascular lesions in man subjected to drug therapy are discussed.     

Mechanical Buckling of Veins Under Internal Pressure

Venous tortuosity is associated with multiple disease states and is often thought to be a consequence of venous hypertension and chronic venous disease. However, the underlying mechanisms of vein tortuosity are unclear. We hypothesized that increased pressure causes vein buckling that leads to a tortuous appearance. The specific aim of this study was to determine the critical buckling pressure of veins. We determined the buckling pressure of porcine jugular veins and measured the mechanical properties of these veins. Our results showed that the veins buckle when the transmural pressure exceeds a critical pressure that is strongly related to the axial stretch ratio in the veins. The critical pressures of the eight veins tested were 14.2 ± 5.4 and 26.4 ± 9.0 mmHg at axial stretch ratio 1.5 and 1.7, respectively. In conclusion, veins buckle into a tortuous shape at high lumen pressures or reduced axial stretch ratios. Our results are useful in understanding the development of venous tortuosity associated with varicose veins, venous valvular insufficiency, diabetic retinopathy, and vein grafts.     

Infrahepatic inferior caval and azygos vein formation in mammals with different degrees of mesonephric development

Controversies regarding the development of the mammalian infrahepatic inferior caval and azygos veins arise from using topography rather than developmental origin as criteria to define venous systems and centre on veins that surround the mesonephros. We compared caudal‐vein development in man with that in rodents and pigs (rudimentary and extensive mesonephric development, respectively), and used Amira 3D reconstruction and Cinema 4D‐remodelling software for visualisation. The caudal cardinal veins (CCVs) were the only contributors to the inferior caval (IVC) and azygos veins. Development was comparable if temporary vessels that drain the large porcine mesonephros were taken into account. The topography of the CCVs changed concomitant with expansion of adjacent organs (lungs, meso‐ and metanephroi). The iliac veins arose by gradual extension of the CCVs into the caudal body region. Irrespective of the degree of mesonephric development, the infrarenal part of the IVC developed from the right CCV and the renal part from vascular sprouts of the CCVs in the mesonephros that formed ‘subcardinal’ veins. The azygos venous system developed from the cranial remnants of the CCVs. Temporary venous collaterals in and around the thoracic sympathetic trunk were interpreted as ‘footprints’ of the dorsolateral‐to‐ventromedial change in the local course of the intersegmental and caudal cardinal veins relative to the sympathetic trunk. Interspecies differences in timing of the same events in IVC and azygos‐vein development appear to allow for proper joining of conduits for caudal venous return, whereas local changes in topography appear to accommodate efficient venous perfusion. These findings demonstrate that new systems, such as the ‘supracardinal’ veins, are not necessary to account for changes in the course of the main venous conduits of the embryo.     

髂静脉压迫综合征的造影表现

目的：探讨髂静脉压迫综合征的造影方法及表现。方法：对79例髂静脉压迫综合征患者行血管造影检查，其中单纯下肢深静脉顺行造影17例，另62例加做股静脉插管造影。结果：79例患者髂静脉均有不同程度的狭窄，左侧72例，右侧6例，双侧1例；其中髂静脉病变部位近端增宽、密度减低25例，局部狭窄23例，充盈缺损14例，正位造影正常、侧位造影明显狭窄14例，髂静脉闭塞3例。所有患者显示不同程度的股静脉瓣膜返流。结论：血管造影是诊断髂静脉压迫综合征最确切和实用的方法。     

Pathology of angiodysplasia in Klippel-Trenaunay syndrome

Klippel-Trenaunay syndrome is a congenital angiodysplasia consisting of the triad of angiomas, osteohypertrophy and venous varicosities. Visceral involvement is not uncommon and may cause life-threatening complications. Presented here is a detailed study of the pathology of angiodysplasia in Klippel-Trenaunay syndrome. Venous fibromuscular dysplasia is the most prominent and consistent vascular lesion other than the cavernous hemangioma which is not unique to this syndrome. Dysplastic veins may also have deformed, insufficient, or absent valves. No agenesis or atresia of the deep veins is found in this series of patients.     

胫后血管逆行皮瓣及所携带游离皮瓣血液循环形态学研究

目的：研究带血管蒂逆行皮瓣及其所携带的游离皮瓣血供与静脉回流机理，为受区无可供吻合血管、特殊类型严重肢体创伤修复提供解剖学基础。方法：１４侧新鲜下肢标本，分别进行小腿主干动脉乳胶灌注和动脉铸型；摹拟术式设计灌注墨汁和Ｘ线血管造影；摹拟术式行胫后静脉逆行加压灌注试验。观察主干血管间的分支吻合、皮瓣血供来源途径及静脉回流方式。结果：小腿主干血管间有粗大的交通支和多途径的吻合，逆行皮瓣静脉血通过深—深、深—浅静脉间的交通支而逆流。结论：胫后动脉与胫前动脉、腓动脉间的广泛交通吻合是设计胫后动脉逆行皮瓣及所携带游离皮瓣血供的形态学基础；静脉瓣节段性失效是此型皮瓣静脉回流的主要方式。     

Chirurgische Therapie der akuten und embolisierenden tiefen Beinvenenthrombose — Indikation,Technisches Prinzip,Ergebnisse

Summary Between 1977 and 1986, 185 patients with deep venous thrombosis (117 with acute occlusive and 68 with embolizing deep venous thrombosis) underwent venous thrombectomy with arterio-venous fistula. The early patency rate was 96%, and the perioperative mortality rate, 3.8%.Of the 157 patients in whom extremities were involved, 147 were examined 12–118 months postoperatively (mean 43±23 months) clinically, by Doppler ultrasound and by light reflexion rheography (LRR). In 49% of the patients, various kinds of swelling or oedema of the involved extremities were present. There were no hemodynamical disturbances in 53% (LRR-examination); competent venous valves were found in 44%. According to the severity of symptoms and hemodynamical findings, postthrombotic syndrome was absent in 47%, mild in 20%, moderate in 28%, and severe in 5% (7 patients, 4 with venous ulcers). Six of the 7 patients with severe postthrombotic syndrome belonged to the group operated for embolizing thrombosis, where no selection of cases was performed. The best long-term results were achieved in patients operated for acute occlusive thrombosis of the iliac and iliofemoral veins.Venous thrombectomy with av fistula can achieve sufficient early and long-term results in the treatment of deep venous thrombosis, provided strict selection of patients and a meticulous technique are practised.

---

Abkürzungsverzeichnis av-Fistel Arterio-venöse Fistel - LE Lungenembolie - LRR Lichtreflexionsrheographie - PPG Photoplethysmographie - PTS Postthrombotisches Syndrom - TVT Tiefe Venenthrombose - USD Ultraschall-Dopplersonographie     

Morphological and mechanical properties of small mesenteric arteries and veins in spontaneously hypertensive rats

Segments of small mesenteric arteries (—150 μm lumen diameter) and of corresponding veins were taken from 5-month-old spontaneously hypertensive rats (SHR) and from age matched Wistar Kyoto (WKY) controls. The segments were mounted on a myograph which enabled their mechanical and morphological parameters to be investigated simultaneously. Compared with the WKY arteries the lumen diameter of the SHR arteries was smaller while the media thickness and active wall tension response were greater. On the other hand there were no differences between the corresponding veins from SHR and WKY animals although, compared with the arteries, the veins had a greater lumen diameter, a smaller media thickness and a smaller tension response. The findings suggest that the morphological and mechanical differences seen in arteries from SHR are not found on the venous side.     

Pulmonary lymphatics and their spatial relationship to venous sphincters

Background: Pulmonary lymphatics are critical to clearing lung fluid. Although their structure can be shown with light and transmission electron microscopy, scanning electron microscopy of their casts can better show their number, size, shape, distribution, and degree of filling. This technique has identified four forms of lung lymphatics, but these forms have not been fully evaluated by tissue microscopy. A most important site of pulmonary edema formation, the pulmonary capillary, is just upstream from small veins which have focal, smooth muscle tufts termed venous sphincters. Because of their constricting potential, these sphincters may control lung perfusion and cause edema. Methods: With light and transmission electron microscopy of tissue and scanning electron microscopy of casts, the lymphatic forms were explored in relation to the tissue anatomy in rats without pulmonary edema and with mild-to-moderate edema caused by extended vascular rinsing. Results: The edematous lungs had increased sacculo-tubular lymphatics adjacent to the venous sphincters. These lymphatics were in the adventitial connective tissue and were partially endothelialized. As lymphatics became more tubular their endothelium became more complete. Collagen fibers traversed the lumen of these lymphatics even where endothelial cells were present and caused the lines on the surface of the lymphatic casts. Overlapping endothelial cells caused clefts on the casts. Conclusions: Scanning electron microscopy of lymphatic casts better defines their ultrastructure and shows the spatial relationship of veins and their sphincters to venous lymphatics. Sphincter contraction may influence pulmonary lymph production which could affect other aspects of regional lung perfusion. © 1995 Wiley-Liss, Inc.     

The vasculature of the rat penis: A scanning electron microscopic and histologic study

As a basis for understanding the mechanism of erection in an animal model frequently used in research in reproductive biology, the angioarchitecture of the penis of the rat has been described using scanning electron microscopy. Study of the penile vasculature of the rat indicates that the corpora cavernosa penis and the corpus spongiosum are independent erectile tissues, each with its own arterial and venous vessels. The large vascular spaces and abundant smooth muscle of the penile crura are compatible with its role in regulating blood flow to more distal penile tissues. Helicine arteries of the crura, but not the parent deep penile artery or arteries elsewhere, have muscular cushions in their walls. The venous drainage of the penile crura is via subtunical veins which are thought to be compressed during erection to elevate pressure within the penis. Large, paired cavernous veins drain the shaft of the penis. A unique method for inhibiting blood flow from the penis is indicated by the division of the cavernous veins into smaller channels prior to joining the subtunical venous plexus. Erectile tissue in the bifid origins of the corpus spongiosum has abundant cavernous muscle, while in the remainder of the corpus spongiosum little smooth muscle lines the cavernous spaces. The cavernous spaces on either side of the urethra coalesce to form vessels, each of which communicates with cavernous spaces in the glans. In addition, a bypass of the glans is effected by communication of these vessels directly with the deep dorsal vein. The apparent absence of muscular pads in vessels of the spongiosum, the relative paucity of cavernous smooth muscle, and the ample venous drainage provided by the deep dorsal vein may account for the lack of a venous occlusive mechanism similar to that of the corpora cavernosa penis.     

Pulmonary lymphatic filling is increased in spontaneously hypertensive rats

Extravascular lung liquid must rely on tissue-space pressure gradients to drive it into the lymphatics because the fluid is outside the lymphatic contractile pumping and valve control. Focal tissue pressure changes could result from muscular contraction in the blood vessel walls. Perivascular lymphatics usually lie within the adventitia of pulmonary blood vessels, and are generally more noticeable in veins than arteries. Spontaneously hypertensive rats have exaggerated focal pulmonary venous muscle (venous sphincters). These muscular tufts are often near initial lymphatics; if their contraction was important for lymph transport, spontaneously hypertensive rats could have more lymphatic filling in the areas of the pulmonary venous sphincters than normotensive rats. Because the focal muscularity is found in pulmonary veins more than arteries, veins may have more focal lymphatic filling than arteries. To test these hypotheses, lung histology and vascular and lymphatic casts of spontaneously hypertensive and normotensive rats were examined. Contracted venous sphincters were found on 108 of 127 veins with lymphatics in the spontaneously hypertensive rats and 5 of 41 in the normotensive rats P<0.01). The spontaneously hypertensive rats had deeper venous contractions and more lymphatic filling around both arteries and veins (P<0.01). In the hypertensive rats, the venous was greater than the arterial lymphatic filling (P<0.01). On the pleural surface, hypertensive rats also had greater lymphatic filling than controls (P<0.01). This anatomic evidence suggests that pulmonary venous sphincters are associated with focal lymphatic filling, and perivascular muscle action might be a component of the pulmonary lymphatic system.     

Immunohistochemical and ultrastructural study of microvessels in diabetic veins

The aim of this study was to examine the localization and features of the intramural microvessels in the wall of inferior limb veins in diabetic patients. The study was conducted in a group of 10 insulin-dependent diabetic patients, who had suffered inferior limb amputation as a consequence of chronic limb ischemia. Sections of long saphenous and posterior tibial veins were investigated by light and transmission electron microscope. The von Willebrand factor and albumin were detected by immunohistochemical techniques. The results show the presence of numerous microvessels in the intima and inner third of the media layer of the venous wall of the sections studied. These microvessels present morphological and functional modifications in relation to those observed in the control veins. They also showed the presence of endothelial cells migrating from the lumen. The authors conclude that the venous wall of inferior limbs in amputated diabetic patients presents a neovascularization process. Some of the endothelial cells of the venous lumen can also have a role in the angiogenesis.