Pathogenesis of trophic ulcers in varicose veins of the lower extremities]

The work generalized the results of examination of 418 patients with primary varicosity (V) complicated by trophic ulcers. On the basis of the study conducted by the authors, a conception of pathogenesis is suggested, the main links of which are microcirculatory disorders in the system of perforating veins of a closed structure, and deficient resolution of fibrin due to diminished local fibrinolytic activity of the plasma. Insufficient fibrin splitting leads to the formation of paravasal collagen cuffs preventing normal exchange between the capillaries and tissues. Impaired nutrition facilitates spasm of arteries and arterioles, whose genesis magnesium deficit contributes to. Activation of collagenolytic peptidases-cathepsins, D, A, B occurs in the ischemic tissues, which leads to destruction of the skin and the formation of ulcers. The disease is attended by disorders of immunity (secondary immunodeficiency), which reduces the reparative processes and thus promotes the development of a chronic process. A complex approach to the treatment of V in the presence of trophic ulcers is suggested.     

Pathogenesis and surgical tactics in varicose ulcers of the lower limbs

The character and specific features of the venous blood circulation in lower extremities were determined by clinico-angiographic studies in 358 patients with trophic ulcers resulting from varicose disease of lower extremities. Causes of the formation of the ulcer are analyzed, methods of correcting the disturbed venous hemodynamics are proposed in relation to the pathology revealed. Indications for dissection of the ulcer are developed.     

Endovenous therapy for varicose veins of the lower extremities

Endovenous treatment for varicose veins of the lower extremities is an old technique. New technologies such as radiofrequency and laser have revived its indications. Thermal energy which is delivered to the vein wall results in a fibrous retraction and eventually complete obstruction of the vessel.     

The pathogenesis and surgical treatment of trophic ulcers of the lower extremities against a background of varicose veins

The state of the musculo-venous pump of lower extremities was studied in 72 patients with trophic ulcers caused by varicose disease. The methods used were: phlebotonometry, phleboplethysmography, US dopplerography, distal ascending and retrograde-femoral, popliteal and talocrural phlebography. It was established that ectasia and/or valve incompetence of deep and muscle veins of the lower extremities with the formation of blood refluxes along the profound, communicating and superficial veins underlie the disturbances of venous hemodynamics. The authors propose a scheme of pathogenesis of the varicose disease trophic ulcers and recommend to perform pathogenetically justified operations.