Objective To study the effectiveness of substitute valve at the popliteal vein in treatment of deep venous valve insufficiency of lower extremities. Methods From January 1996 to August 2002, 27 patients were diagnosed having deep venous valve insufficiency of lower extremities by color Doppler and radiography with an average disease course of 17.4 years.All 27 patients had varicose vein, 25 pain, 22 swelling,25 pigmentation in ankle area and 19 chronic ulcerations.Two cases had been treated with great saphenous vein ligation and striping.Averagevein pressure in resting position was (11.00±0.73)kPa,and the ambulatory venous pressure was (9.14±0.68)kPa.All patients were treated with substitute valve at the popliteal vein,and great saphenous vein ligation and stripping, some were treated with subfascial endoscopic perforating veins ablation. Results The average ambulatory venous pressure after operation was (5.94±0.82)kPa,were significantly different from that before operation(P＜0.01). The curative results were satisfactory,and all symptom and physical sign disappeared.After a mean follow-up period of2-6 years,21 cases had satifactory results. Conclusion Substitute valve at the popliteal vein have the value of widespread application.
Objective To evaluate improved effect for deep venous valve function after superficial vein surgery of lower extremity in the intermediate stage. Methods Totally 43 patients (55 limbs) with varicose veins of lower extremity were enrolled to accept surgical management of vein systems in our department from March 2006 to October 2006. All patients were respectively followed up after 6 months and 4 years about the changes of deep venous valve function with color Doppler ultrasonography. Results Thirty-nine patients’ deep venous valve function kept well up to now, and there was no significant difference between the two results. Four patients without proximal saphenous vein ligation recurred, and there was reflux in deep venous. Conclusion Endovenous laser treatment and ablation of varicose veins of lower extremity with deep venous insufficiency could improve deep venous valve function effectively. Proximal great saphenous vein ligation is important for successful operation.
目的 评价股浅静脉瓣膜环形缩窄术治疗原发性下肢深静脉瓣膜功能不全(primary deep venous insufficiency,PDVI)的疗效和应用价值。方法 2002年4月至2006年4月期间经顺行性静脉造影加Valsalva试验证实为PDVI者119例(158条),其中2002年4月至2004年1月收治者仅行大隐静脉高位结扎剥脱+交通支结扎术(前期治疗组),2004年2月至2006年4月收治者在前期治疗方法的基础上加行股浅静脉瓣膜环形缩窄术(后期治疗组),以CEAP(clinical,etiologic,anatomic,and pathophysiologic)临床分级与临床记分评价2组的疗效。结果 2组患者术后临床分级及临床记分均明显下降(前期治疗组由5.9±3.6降至2.1±1.3,P＜0.01; 后期治疗组由6.4±3.5降至1.7±1.8,P＜0.01),且后期治疗组较前期治疗组下降程度更大(P＜0.01)。结论 股浅静脉瓣膜环形缩窄术有助于PDVI患者临床症状缓解,因此术前明确诊断为PDVI的患者,应行股浅静脉瓣膜环形缩窄手术。
【Abstract】Objective To evaluate the clinical value of photoplethysmography (PPG) in the diagnosis of venous valvular incompetence of lower extremity. Methods Two hundreds and six lower limbs in 181 patients including primary deep venous incompetence(PDVI), simple superficial veins incompetence and simple cross veins incompetence were examined by PPG in the assessment of venous refill time(VRT). All limbs underwent deep vein venography. Results Using venography as control the sensitivity of PPG was 89.8% and the specificity was 83.3 % in the diagnosis of venous valvular incompetence of lower extremity. Conclusion PPG could be taken as clinical diagnostic method for venous valvular incompetence of the lower extremity. The feature of PPG is noninvasive, painless with nonallergic reaction. The authors suggest that PPG can be used as a screening procedure for performing venography and postoperative follow-up.
周围静脉疾病是临床上的常见病和多发病，其发病率为20%～40%，皮肤营养障碍占2%～5%［1，２］ ,发病率比动脉疾病约高10倍，发病机理比动脉疾病复杂，分类方法亦不一致，至今存在着争论。下肢慢性静脉功能不全（chronic venous insufficiency,CVI）按其病因可分为原发性、继发性及先天性; 按解剖范围可分为浅、深和交通静脉3个系统，亦即包括浅静脉曲张、深静脉瓣膜功能不全、深静脉血栓形成后遗症、交通静脉瓣膜功能不全等［３，４］。多年来下肢浅静脉曲张主张施行大隐静脉高位结扎加剥脱术，但术后复发者较多。近年来，随着国内、外学者对CVI的深入研究，尤其是对深静脉瓣膜功能不全的认识，使传统下肢浅静脉曲张的概念发生了根本转变。下肢浅静脉曲张已不再被认为是一个独立的疾病，而是一种可由多种不同病因引起的共同临床表现……
ObjectiveTo analyze the causes of lower extremity varicose veins and assess the value of deep vein imaging in diagnosing and treating venous diseases, according to deep vein angiography examination results under digital subtraction angiography. MethodsDuring January 2012 to January 2013, 689 cases of lower limb varicose veins in 394 patients underwent lower extremity deep venous anterograde contrast examination, among which 87 patients also underwent left femoral venous trocar puncture angiography examination and 46 patients underwent femoral vein puncture inferior vena cava angiography examination at the same time. Then the results of imaging data were analyzed. ResultsThe causes of lower limb varicosity, according to its incidence, were as follows:primary deep venous valve incompetence (349 limbs of 184 patients) accounting for 50.7%, simple varicose veins of lower limbs (148 limbs of 95 patients) accounting for 21.5%, left iliac vein compression syndrome (121 limbs of 69 patients) accounting for 17.6%, cloth plus syndrome (54 limbs of 34 patients) accounting for 7.8%, post-thrombotic syndrome (16 limbs of 11 patients) accounting for 2.3%, and Klipple-Trenaunay syndrome (1 patient) accounting for 0.1%. ConclusionVaricose vein of lower limb is a common clinical manifestation of a variety of diseases, and the primary deep venous valve incompetence is the leading cause. Varicose veins of lower limb deep vein angiography is a reliable method for examination of lower extremity venous disease, and a basis for the choice of other treatments as well.
In order to evaluate the effect and indication of three kinds of deep-venous valve reconstruction surgery, 62 cases with venous reflux disease of the leg had been treated from Jan. 1992 to Jun. 1996. All the patients had varicose vein and tingle in varying degrees, besides swelling in 30 cases, pigmentation in 28 cases, ulcer in 14 cases. The course of disease ranged from 1 to 30 years (averaged 14.6 years). METHOD: 14 cases were treated by ringing of the superficial femoral venous 1st valve, 1 case was treated by repairing of the superficial femoral venous 1st valve, 47 cases were treated by formation of substitute valve outside the popliteal vein. The symptoms of all the patients were alleviated with an average follow-up for 20 months. Fourteen cases with ulcer were healed compeletely and no recurrence. The conclusion were: 1. ringing and repairing of the venous valve were suitable for level I-II venous valvular incompetence. 2. formation of substitute valve outside the popliteal vein was suitable for level III-IV venous valvular incompetence or congenital valvular defect. 3. the width of the ringing material should be increased to 2 cm according to the pathological basis. 4. both femoral veins should be ringed in the treatment of primary valvular incompetence of double deep vein deformity. 5. the formation of substitute valve outside the popliteal vein was also available in the treatment of popliteal vein with many branches.
ObjectiveTo compare vein valve function following pharmacomechanical thrombolysis (PMT) with simple catheter-directed thrombolysis (CDT) for deep vein thrombosis.MethodsWe retrospectively analyzed the clinical data of sixty patients who suffered acute lower extremity deep vein thrombsis in our hospital between October 2016 and March 2017. All patients underwent contralateral preprocedural duplex and bilateral postprocedure duplex to access patency and valve function. The patients were divided into three groups including a group A with catheter-directed thrombolysis (CDT) alone (36 patients with 20 males and 16 females at average age of 56 years), a group B with PMT alone (15 patients with 8 males and 7 females at average age of 55 years), and a group C with PMT combined CDT (9 patients with 4 males and 5 females at average age of 56 years). The valve function was compared among the Group A, Group B and Group C.ResultsThere were 40.0% (24/60) patients with bilateral femoral vein valve reflux, 40.0% (24/60) patients with unilateral femoral vein valve reflux (all in the treated limbs), 20% (12/60) patients had no reflux in both limbs. Of the limbs treated with CDT alone, PMT alone and PMT combined CDT, the rate of valve reflux was 38.9% (14/36), 33.3% (5/15), and 55.6% (5/9) respectively (P=0.077).ConclusionIn the patients suffering acute DVT, PMT or PMT combined CDT does not hamper valve function compared with CDT alone.
In order to salvage the extremity of dog with marked ischemia from extensive damage of the artery, an operation, diversion of saphenous artery and vein with the anterior tibial artery and vein was tried. The results showed that this operative technique was feasible as a method of treatment. Basing on this fact, the diversion of the saphenous vein in situ with the femoral artery, combined with selective extirpation of the valve of thd vein was used to treat 14 cases (15 limb) of high obliteration of artery of the lower extremities with good results.