下肢股Ge静脉瓣功能的观察

目的：观察下肢股Ｇｅ静脉瓣的功能。方法：３０例下肢深静脉良好的单纯性大隐静脉曲张２，经Ｇｅ静脉穿刺下肢深静脉造影、透视下观察股Ｇｅ静脉瓣膜的活动．结果：当病人作Ｖａｌｓａｌｖａ运动（吸气后屏气）时，股Ｇｅ静脉瓣均发生关闭；当病人作足屈伸运动时，股静脉瓣发生半开放、半关闭活动，但Ｇｅ静脉瓣完全关闭和开放活动。结论：Ｇｅ静脉瓣主要功能是参与小腿肌肉泵的活动，股静脉瓣的主要功能是抗逆向压力。     

腘静脉肌袢形成术近展

下肢深静脉功能不垒是血管外科常见病。文献报道,英国患病率为总人口的0.5％,加拿大则为20％。许多学者对下肢深静脉功能不全作了系统深入的研究,创用了一些新的手术方法,如股浅静脉瓣膜修复术,自体带瓣静脉段股浅静脉移植术,静脉移位术等,而由Psathakis首创的腘静脉肌袢形成术(又称腘静脉瓣膜替代术),具有操作简便,不涉及静脉本身、安全有效等优点,特别是80年代以后,改变了对下肢静脉系统疾病的传统看法,重新明确了手术适应证,从而日益受到重视,并逐渐在临床推广。本文旨在将本手术适应证,病人的选择,手术方法,作用机理和疗效评价等问题加以述评。     

半腱肌-股二头肌腱袢腘静脉瓣膜代替术13例护理体会

<正> 原发性下肢深静脉瓣膜功能不全,大都是在瓣膜薄弱的基础上,长期站立或强体力劳动时,血液重力逆向作用于深静脉瓣膜,使瓣膜功能逐渐减弱,直至丧失,当瓣膜破坏至腘静脉水平时,患者出现下肢沉重,酸胀,站立后疼痛,浅静脉曲张加重,足靴区皮肤因淤血、缺氧、红细胞破坏出现色素沉着、湿疹、溃疡及坏死出血、病人痛苦加剧,影响工作和生活。我院外科自1998年元月至19四年8月开展半腱肌—股二头肌腱袢腘静脉     

静脉瓣膜移植术

对下肢深静脉炎后综合征来说,各种非创伤性检查,仅能作为筛选手段,唯有静脉造影,才能对病变作出正确判断。作者主张逆行造影应经肱静脉途径,如插管遭遇困难,可改经锁骨下静脉,向患侧股总静脉插管,其优点是:①如股总静脉瓣膜功能良好,可将导管插入股深静脉开口远侧的股浅静脉,再注入造影剂。这样,可观察到纯然局限于股浅和腘静脉瓣膜功能不全的病变类型。这是经股静脉穿刺插管所难以发现的。②必要时,通过穿刺,能够同时向二侧下肢深静脉插管和造影。造影中根据倒流程度不同,可分为5级:0级,无倒流;1级,倒流不超过大腿上段;2级,倒流到膝;3级,倒流到膝下;4级,倒流入小腿肌肉静脉丛。作者提出,造影前作静脉测压具有相当价值。通过足背浅静脉,先测站立位静息状态压力,然后让病人脚     

腘静脉瓣膜病变在原发性下肢慢性静脉功能不全中的意义

目的:探讨腘静脉瓣膜病变对原发性下肢慢性静脉功能不全(PCVI)发病中的作用.方法:将符合纳入标准的268例PCVI患者资料,依据病变瓣膜位置分为隐股瓣膜病变组、股浅静脉瓣膜病变组、腘静脉瓣膜病变组、股腘静脉瓣膜病变组,每组67例,比较各组Kistner分级,病变静脉节段积分(VSDS),症状(C)分级,临床症状严重程度积分(VCSS),劳动能力丧失程度积分(VDS)的差异性.结果:腘静脉瓣膜病变组在Kistner分级,VSDS,C分级,VCSS,VDS方面均高于隐股瓣膜病变组及股浅静脉瓣膜病变组,差异均有统计学意义(均P＜0.05),而低于腘静脉瓣膜病变组,部分差异有统计学意义(Kistner分级和VSDS)(均P＜0.05).病变瓣膜位置与Kistner分级的相关性有统计学意义(r=0.926,P=0.000),同时Kistner分级与C分级的相关性受性别、年龄、病程因素的影响(均P＜0.05).结论:腘静脉瓣膜病变能造成下肢静脉血液返流程度进一步加重、受累静脉范围进一步扩大,及临床症状加重、劳动能力降低.     

下肢深静脉功能不全诊治的实验和临床研究

目的研究治疗不同程度下肢原发性深静脉瓣膜功能不全的有效方法。方法①观察以自体大隐静脉片、自体阔筋膜片和人造血管片作深静脉瓣膜包窄术的效果;②分别采用股或静脉瓣修复加包窄术、股或（和）静脉瓣包窄术、股浅静脉瓣修复和包窄加静脉瓣包窄术、自体带瓣腋静脉段静脉移植外加人造血管环包术、股静脉瓣包窄加静脉外代瓣术、静脉外代瓣术,共治疗１２１例（１３３条患肢）;③以静脉插管造影和彩色多普勒超声检查作为诊断和评估疗效的观察指标。结果①以膨体聚四氟乙烯人造血管片作包窄材料的效果最好;②彩超检查与静脉造影比较准确率为９１８６％;③本组患者平均随访３７８年,治愈率９１７３％。结论治疗下肢深静脉瓣膜功能不全,应根据病情选用不同的手术方法。     

自体生物肌袢形成术治疗下肢深静脉瓣膜功能不全

原发性深静脉瓣膜功能不全的手术方法种类繁多。腘静脉外肌袢形成术,是治疗严重倒流的首选方法。作者自1989年以来利用半腱肌—股二头肌袢治疗下肢原发性深静脉瓣膜功能不     

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。     

股浅静脉瓣窦环包术治疗原发性下肢深静脉瓣膜功能不全41例

原发性下肢深静脉瓣膜功能不全是倒流性静脉疾病和浅静脉曲张最主要的原因.1998年1月至2003年7月,我科对41例原发性下肢深静脉瓣膜功能不全的患者43条患肢施行股浅静脉瓣窦环包术,取得了满意的治疗效果.     

股深静脉的形态学和血流动力学分析

目的 初步阐明股深静脉在下肢慢性静脉疾病程中的作用。方法 应用顺行静脉造影、双功彩超对104条慢性静脉疾病的患肢进行股深静脉形态学和血流动力学分析。结果 其中19条肢体深静脉顺行造影股深静脉全程显影，13条肢体股深静脉主干与腘静脉或股浅静脉远端直接相交通，5条肢体股深静脉通过数条细小分支与腘静脉或股浅静脉远端直接相交通。双功彩超检查显示：下肢深静脉顺行造影股深静脉全程显影者均有明显的股深和腘静脉倒流，股深静脉全程显影者其近端股深静脉管径明显大于股深静脉未全程显影者。结论 根据本组资料所示：股深静脉在形态学上可分为5型，股深静脉显影与股深静脉倒流密切相关，Ⅱ型和Ⅲ型股深静脉倒流影响下肢腓肠肌泵功能，这类思考，静脉瓣膜重建应选择在股浅与股深静脉远端相交通的部位之下即腘静脉或同时行股浅与股深静脉瓣膜重建术。     

下肢深静脉功能不全的检测与修复材料选择的研究

目的寻找下肢深静脉瓣膜包窄术最佳环包材料,了解彩色超声多普勒对深静脉瓣膜功能不全的诊断价值和月国静脉瓣膜功能。方法观察以自体大隐静脉片、自体阔筋膜和人造血管片作深静脉瓣膜包窄术的效果;彩色超声多普勒与经月国静脉插管造影结果对比;月国静脉瓣膜血液动力学检查。结果自体阔筋膜和大隐静脉片逐渐挛缩呈纤维化瘢痕增生,而人造血管的形态和结构无明显变化;彩色超声多普勒与经月国静脉插管造影检测下肢深静脉功能比较,前者与后者的符合率为９１．８６％;屏气时股、月国静脉瓣膜同时关闭,小腿三头肌收缩时月国静脉瓣膜开放程度明显大于股静脉瓣膜。结论以人造血管作环包材料效果最好;彩色超声多普勒以其无创性成为重要的检测手段;月国静脉瓣膜是保护小腿深静脉功能的最后屏障     

Popliteal valve incompetence and postoperative deep vein thrombosis

In 79 patients undergoing hip or knee replacement surgery the preoperative condition of the popliteal vein valves was assessed by Doppler ultrasonography. Presence of postoperative deep vein thrombosis was determined by bilateral ascending phlebography seven to ten days after surgery. Antithrombotic prophylaxis consisted solely of TED stockings and early mobilization. The overall incidence of deep vein thrombosis was 20%. All thrombi were calf vein thrombi. One of these thrombi extended into the popliteal region and two into the femoral region. The incidence of deep vein thrombosis in patients with preoperative popliteal vein reflux when compared with patients with a normal popliteal valvular function was 55-15% (p less than 0.01). The incidence of deep vein thrombosis was also significantly lower in patients operated under epidural anaesthesia compared with patients under general anaesthesia. It is concluded that valvular incompetence of the popliteal vein predisposes to postoperative deep vein thrombosis.     

Significance of popliteal reflux in relation to ambulatory venous pressure and ulceration.

Fifty-one patients (55 limbs) who had had deep venous thrombosis (DVT) extending into the femoral or iliofemoral segment three to five years earlier and ten limbs of ten healthy volunteers were studied. The ambulatory venous pressure (AVP) was measured by inserting a needle in a vein on the foot; the presence of reflux in the popliteal vein was determined by a directional Doppler ultrasonic blood velocity detector. All patients had ascending venography. The results suggest that the most important factor in determining the AVP and ulceration in postthrombotic limbs is the condition of the popliteal valves. Ulceration does not occur even in the presence of occlusion if the popliteal valves are competent. The extent of DVT and recanalization or the failure of recanalization is of secondary importance.     

Valvular reflux after deep vein thrombosis: incidence and time of occurrence.

From December 1986 to December 1990, 268 patients with acute deep vein thrombosis were studied in our laboratory. From this group 107 patients (123 legs with deep vein thrombosis) were placed in our long-term follow-up program. The documentation of valvular reflux and its site was demonstrated by duplex scanning. The duplex studies were done at intervals of 1 and 7 days, 1 month, every 3 months for the first year, and then yearly thereafter. The mean follow-up time for these patients was 341 days. In addition, reflux was evaluated in 502 patients with negative duplex study results and no previous history of deep vein thrombosis or chronic venous insufficiency. In the patients with acute deep vein thrombosis, valvular incompetence was noted in 17 limbs (14%) at the time of the initial study. Reflux was absent in 106 limbs (86%). In this last group reflux developed in 17% of the limbs by day 7. By the end of the first month, 37% demonstrated reflux. By the end of the first year, more than two thirds of the involved limbs had developed valvular incompetence. The distribution of reflux at the end of the first year of follow-up was the following: (1) popliteal vein, 58%; (2) superficial femoral vein, 37%; (3) greater saphenous vein, 25%; and (4) posterior tibial vein, 18%. Reflux seems to be more frequent in the segments previously affected with deep vein thrombosis. Among cases where segments were initially affected with thrombi, after 1 year the incidence of reflux was 53%, 44%, 59%, and 33% for the common femoral vein, superficial femoral, popliteal vein, and posterior tibial vein, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Percutaneous transpopliteal venography

The authors advocate percutaneous transpopliteal venography as a new method for evaluating the function of deep venous valves of the lower extremity. At the popliteal fossa, the popliteal vein was punctured and a catheter was inserted cephaladly for venographic study of the valves. By this method, not only the ilio-femoropopliteal vein was clearly visualized, also the competence of the valves in this venous segment may accurately be tested one by one, thus making up the shortcomings of the ascending and descending venography. It was found, through this venography, that even if the highest valve of the superficial femoral vein was competent distal valves in the femoral and popliteal veins may become incompetent resulting in primary valvular incompetence of the deep veins in the lower extremity.     

Importance of valvular incompetence after acute deep venous thrombosis.

The color Doppler scanner was used to analyze acute deep venous thrombosis in 14 patients. A thrombus was found in the superficial femoral vein in 4 patients and in the superficial femoral and popliteal veins in 6 patients; a popliteal occlusion was found in 4 patients. All 14 patients were treated with intravenous heparin followed by at least 3 months of warfarin therapy. Patients were re-examined between 24 and 48 months. Six patients were symptomatic; 8 were asymptomatic. Five patients had occluding thrombus in the distal popliteal vein; major competent collateral channels developed from the proximal superficial femoral vein, and they remained asymptomatic. Three patients whose superficial femoral veins recanalized without valvular incompetence were asymptomatic. Valvular incompetence was observed in all of the symptomatic patients. Patients with persistent popliteal occlusion and collateral channels have fewer symptoms than patients with valvular incompetence in the superficial femoral and popliteal veins.     

Phlebographic evaluation of nonthrombotic deep venous incompetence: new anatomic and functional aspects

The anatomy, valvular function, and reflux patterns in the deep veins of the lower extremities were studied by ascending and descending phlebography in 126 limbs with nonthrombotic deep venous incompetence. The most common patterns were isolated reflux in the superficial femoral vein (51%), and combined reflux in the superficial femoral and the deep femoral veins (44%). Isolated deep femoral vein reflux occurred in 5%. As the degree of reflux in this vein varied considerably, a grading system for classification of deep femoral vein reflux was proposed. Depending on variations in the deep femoral vein anatomy, four different patterns could be distinguished. This study demonstrated that contrast filling of the deep femoral vein during ascending phlebography may indicate the presence of reflux in this vein. Complete visualization of the deep femoral vein is a new diagnostic sign that strongly correlates (p less than 0.001) with reflux in the deep femoral vein. The mean number of valves in the superficial femoral vein was reduced with increasing degree of reflux compared with a reference group consisting of 41 extremities without reflux. The diameter of the popliteal vein was significantly increased in the presence of pathologic reflux, which may indicate that vein wall dilation is a major cause of primary nonthrombotic deep venous incompetence.     

Reconstructive venous valve surgery]

The indication for venous valves surgery has to consider morphological and functional aspects. 36 reconstructive valve repair procedures and the long-term results are reported. The procedures need surgical skill and a meticulous operation technique. Primary idiopathic valvular incompetence can be treated with a direct valvuloplasty (Kistner). The leaflets of the floppy valve become shortened either by an open repair or with a closed procedure. Patients suffering from post-thrombotic syndrome showing intact valves in the deep femoral vein may undergo a transposition operation. In this case the superficial femoral vein is implanted end to side into the deep femoral vein distally to a proximal valve. The best results in post-thrombotic syndrome are achieved with a free transplantation of a venous valve from the axillary vein into the superficial femoral or into the popliteal vein (Taheri). Postoperatively the patients are anticoagulated and have to wear a compressing stocking (Grade III). The results of direct valvuloplasty (Kistner) and valve transplant (Taheri) are satisfactory, whereas the results of transposition seem to be disappointing. Good results are depending mostly on a correct indication for the operation and on avoiding the contraindications.     

Valvular incompetence in superficial, deep and perforator veins of limbs with varicose veins

Venous valvular incompetence was investigated with Doppler technique in 296 limbs with untreated primary varicose veins. Partial or complete insufficiency of the long saphenous vein was found in 95%. Six patterns of incompetence of this vein could be distinguished. Insufficiency of the short saphenous vein was present in 15% of the limbs and perforator incompetence in 45%. Femoral and/or popliteal vein reflux was found in 20% of the limbs. In eight limbs (2.7%) with verified primary deep venous insufficiency there was a moderate or severe degree of femoral and popliteal venous reflux. Skin changes secondary to the venous disease were present in 18% of the limbs, mainly those with incompetence of perforator and long saphenous veins. Doppler investigation of varicose limbs give valuable information and can be recommended as a standard pre-treatment test.     

Influence of the profunda femoris vein on venous hemodynamics of the limb. Experience from thirty-one deep vein valve reconstructions

Venous valve reconstruction in 31 limbs (28 patients) with chronic deep venous insufficiency is analyzed. The indications for operation were primary or secondary deep valvular incompetence with severe reflux and venous hypertension. Valvuloplasty was performed on a proximal valve of the superficial femoral vein (SFV) in 17 limbs and on a common femoral vein valve in two limbs; transplantation of a valve-bearing segment of the axillary vein was made to the common femoral vein in two limbs, to the SFV in seven limbs, and to the popliteal vein in three limbs. The results of valvuloplasty were satisfactory, with six failures observed during a follow-up period extending to 84 months (mean, 44 months). Eight of 12 valve transplant reconstructions failed within 2 years. Patency and competence of the reconstruction were obtained in 27 limbs at the 6-month postoperative control period. The effects on venous pressure were analyzed regarding the presence or absence of reflux into the profunda femoral vein (PFV) with preoperative retrograde phlebography. The results showed significant reduction of the ambulatory venous pressure (p less than 0.05) and increase in venous recovery time (p less than 0.01) in limbs with PFV competence. In limbs in which the PFV was incompetent the pressure values remained unchanged. These findings suggest that the functional state of the PFV is of great importance to the venous hemodynamics of the limb. This study also indicates that the principle of one-level repair in the SFV seems appropriate in limbs with a competent PFV.