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PubMed2001

[Phlebological diagnosis. Phlebography of the veins of the lower extremity].

Phlebography should be weighed up against the current sonographic techniques (Doppler and Duplex) applied for visualization of venous disorder along the lower extremity veins, following a decision tree considering completeness and quality of documentation wanted, invasiveness and clinical consequences expected in the individual case. Ascending leg phlebography, incorporating Valsalva's manoeuvre, means the up-to-date standard technique, offering morphologic and functional information. Varicography and additional phlebographic techniques are considered to be additive, solving special problems, having not been visualized by the standard phlebography before. Combined phlebography and peripheral blood pressure measurements may improve the output of functional informations within one session. Quality standards of phlebography have to include standardized technique of phlebography, of documentation and interpretation, dealing with the special aspects of varicose syndrome, acute thrombosis and the post-thrombotic syndrome.

Humans↗
PubMedDate not supplied

[Painful manifestations of the sequelae of phlebitis].

Pain may be absent from the various manifestations making up a post-phlebitis syndrome but when it is present it varies considerably from one patient to another. Thus the very common feeling of heaviness, generally not painful, may be perceived as being painful by certain patients either because of the particular severity of the feeling or because of a low pain threshold in certain cases. Since no method for the objective measurement of pain exists, the assessment of this symptom and of its severity remains highly subjective, most often based upon statements by the patients. However, in practice a distinction can be drawn between the following: Pain related to venous stasis: a simple feeling of heaviness most often but which, in certain patients, may take on a painful connotation. Among such "stasis" pains, particular mention must be made of venous intermittent claudication, a progressive feeling of calf tension during walking which becomes increasingly painful and finally forces the sufferer to stop. This symptom is generally linked to the obstruction of a large collecting vein. Pain accompanying a leg ulcer usually results from secondary infection. Mention may be made of the role of inflammatory lesions developing around the trophic problem and which may encompass nerves, in particular the internal saphenous nerve. Although classical, causalgia type pain is certainly rarer. Demyelinisation of peripheral nerves has been suggested as being at its origin. Once again, the role of inflammatory processes linked to secondary infection appears to be notable. The treatment of pain in a post-phlebitis patient must take the greatest possible account of the pathophysiology of the post-phlebitis syndrome responsible: disinfection of a leg ulcer, treatment of venous stasis by elastic support, or by surgery or sclerosing injections. Sympathectomy has been suggested in causalgia type pain. In fact, this operation has scarcely any indications in post-phlebitis syndrome.

Humans↗
PubMed1992

Rheology of the post-thrombotic syndrome.

Due to its non-Newtonian behaviour, blood rheology should matter most in those parts of the circulation where the shear stresses are low, i.e. on the venous side of the vascular tree. Yet we know little about haemorheology in the venous system or in venous diseases. According to previous results, there is a significant rheological deficit in the presence of a venous thrombosis or its risk factors. This trial was designed to determine the flow properties of blood in post-thrombotic (PTS) syndrome. Patients suffering from PTS are compared to controls in terms of ex vivo rheological measurements to quantify the rheological behaviour of blood: blood and plasma viscosity, haematocrit, red cell aggregation, red cell filterability, erythrocyte sedimentation rate (ESR), plasma fibrinogen. The comparison shows that plasma viscosity, red cell filterability, ESR and fibrinogen differ significantly between patients and controls indicating a lack of blood fluidity in PTS. It is suggested that the rheological deficit and the venous pathology contribute to a disturbed microcirculation in the affected limb. The combination of both abnormalities might be crucial in causing the typical symptoms of post-thrombotic syndrome.

Adult↗
PubMed2001

[Chronic venous compartment syndrome].

Various forms of compartment syndrome can now be distinguished. Acute compartment syndrome is the result of a discrepancy between the volume of the compartment and its contents. This leads to increased pressure at rest and during load, which cuts off the micro-circulation and hence destroys the intracompartmental structures. Chronic compartment syndrome had only been seen in athletes and soldiers up to now. The disease mainly affects the anterior compartment and the fibular muscle group, and only rarely the lateral muscle compartment. In the course of severe venous diseases, a chronic venous compartment syndrome develops which is fundamentally different from the clinical pictures previously known. The cicatricial destruction of the crural fascia exerts an effect on the intracompartmental pressure with every step the patient takes. In severe cases, this results in considerable changes in the muscles involving chronic ischaemia associated with necrosis and glycogen deficiency. Further investigations are necessary in order to define the clinical picture, particularly by measuring the intracompartmental pressure under dynamic and standardised conditions. We suggest also making a verbal distinction between the two forms: a chronic exertional compartmental syndrome and a chronic venous compartmental syndrome.

Chronic Disease↗