[Medical treatment of trophic disorders of arterial origin].
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Biomedical subjects
Publications and source records attributed to H R Van der Molen.
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The author shows that a combination of vascular diseases or anomalies with bone malformations other than the triad described by Klippel and Trenaunay or the Recklinghausen syndrome is not too rare. The author cites half-a-dozen such cases of different types, with anomalies in different parts of the body, from the cranium to the toes. The angiomas varied from naevus vinosus cavernoma, and the bone phy. In some cases the EEG shows pathological features.
The author was, in 1952, the first to draw attention to the possibilities of revascularization of white atrophy. The data which he produced in 1952 have remained correct. Time has amply confirmed them and so, using these data, the author studies the nature of revascularization; he underlines the very important idea following the experiments carried out by Boersma, of rhythmical jarring in the return venous circulation, both superficial and deep, and shows how it is possible to counteract the ill-effects of these veritable battering-ram shocks by means of ambulatory compression perfectly applied. The more the compression offers resistance to the jarring during walking, the more limited the risk of relapse will be. A patient who carefully follows the prescribed treatment has a good chance that the development of the disease will not be crowned by relapse.
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We have made a non-selective search for patients undergoing treatment for more than five years for an arterial deficiency of the lower limbs. Most of the patients studied suffered from intermittent claudications for which surgical treatment was impossible (distal lesions, diabetes, coronaritis) or had failed (sympathectomy, recurrences). Faced with the inefficiency of vasodilators, and in addition to strict medical treatment of the risks factors of arterio-sclerosis disease (tobacco, obesity, hypercholesterol, sedentary habits), we treated these patients using intra-arterial injections according to the method of Reboul. Our patients generally received one injection per week of xylocaine-priscol-pronestyl. Once an improvement appeared, these injections were spaced out so as to become semi-annual. We grouped 67 patients suffering from intermittent claudications and 5 patients suffering from arteritis ulcers. We studied the results obtained from this so-called palliative treatment (the claudication going from an average 201 meters to 3,395 meters after five years and cure of the ulcers).
The discovery of a femoral artery that is clinically non palpable can be made using the Doppler. It is thus possible to use a direct intra-arterial treatment. This is what was done by the authors, who thereby divided the patients into two groups: the first, 22, with non palpable femoral arteries; the second, 20, with palpable femoral arteries. They obtained good results with intermittent claudications, with increase of the walking perimeter, and among the trophic problems they noted, an increase of the walking perimeter, and among the trophic problems they noted, an increase in arterial pressure on the limbs in question, a phenomenon of which they discuss the pathogenic causes.
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After a historical review and a review of classification, the author indicates the reasons which lead patients suffering from vascular dysplasias to consult a phlebologist. The clinical symptoms leading to consultation are haemorrhage, leg ulcer, varicose veins, phlebitis, and large legs. Some cases are presented of each of these clinical disturbances.
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