[Long-term normovolemic hemodilution in refractory postphlebitic ulcers].

Abstract

Thrombo-embolic complications are still amongst the most serious encountered in surgery and in certain medical afflictions, despite the different forms of prophylaxis, and in particular subcutaneous heparin. Thus, in 1983, an investigation by Salleras in Barcelona based on 37,400 cases, assessed the incidence of these complications after surgery at a rate of 2.5%. That is why post-phlebitic syndromes, the results of late diagnosis at the acute stage and/or inappropriate treatment, are disorders which are still very widespread, chronic, and more or less incapacitating. At the root of tissue modifications and trophic disorders which are seen in the post-phlebitic illness, a state of venous stasis at the periphery of the limbs is very often encountered; it depends on the following processes: the obstruction of a large venous collector (obstructive syndrome), the size of the stasis depending on the functional value of the anastomotic channels; the insufficiency of the superficial network; orthostatic reflux in the repermeabilized deep veins whose valvular system has broken down. The main trophic complications are: oedema, hypodermatitis and leg ulceration, which is the most formidable complication and which still occurs very frequently. Most post-phlebitic ulcers heal after a well-executed phlebological treatment on an ambulatory basis. A certain number of these ulcers prove, however, to respond badly to ambulatory treatment; they are called resistant post-phlebitic ulcers. By definition, they are difficult to cure; however, it has recently been apparent that the classical treatments associated with long-term isovolaemic haemodilution are more effective and enable healing to take place by treating the venous stasis and the increased blood viscosity.