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PubMedDate not supplied

[Evaluation of the obstructive factor and its importance in the caval and ilio-caval postphlebitic syndrome].

As regards venous haemodynamic disorders, former caval and ilio-caval phlebites constitute a separate group in the vast structure of phlebitic after-effects. The wealth of collaterals (reminder of the physio-pathology) and the slightest affection of the upper venous system in the case of high isolated thrombosis show that they may be effectively compensated. This idea, already apparent in certain clinical and phlebographical findings, is confirmed by functional investigations, and especially by plethysmography under venous occlusion. It is this method that we have used in this study. We have retained only the lesions of the ilio-caval system considered some way away from the acute stage of the thrombosis (gap of more than 6 months). A first approach, using rheoplethysmography, confirms that the obstructive syndrome associated with caval obstruction alone is generally well compensated by the development of an efficient collateral circulation, and that disorders of venous return, evaluated by the outflow index, are mainly to be seen when the caval obstruction is associated with deterioration of the subinguinal venous system. A second approach showed, by means of a more far-reaching analysis of the parameters using a constrictive mercury gauge that besides venous repermeation and supply through the collateral network a role was played by venous distensibility disorders induced by phlebitis... The maintenance of satisfactory distensibility could therefore come into play as a contributory factor in compensation phenomena. These facts confirm the complexity of post-phlebitic illness; phlebography gives only an incomplete insight into the functional repercussions of the obstructive syndrome; the exection of functional experiments demonstrate that often apparently significant venous obstructions are in fact quite well compensated.

Humans↗
PubMed1994

[Endoscopic venous surgery in postphlebitic syndrome].

Endoscopy of the subfascial space of the lower medial calf is able to demonstrate the morphological changes of perforators in patients with postthrombotic syndrome. Inspection of the subfascial space allows the differentiation of competent and incompetent perforators and a following complete dissection of only incompetent perforators. By means of this method more information about the texture of the fascia cruris can be achieved.

Endoscopes↗
PubMedDate not supplied

[Role of radioisotopic lymphoscintigraphy in postphlebitic syndrome of the legs].

Post-phlebitis syndrome of the lower limbs is a set of symptoms that follow a state of phlebostasis and phlebolymphostasis with consequent oedema and tissue distress. We submitted 36 patients with post-phlebitis syndrome of the lower limbs to radioisotopic lymphoscintigraphy for the purposes of evaluating the vicariant function of the lymphatic system and the possible role of the lymphatic system in the genesis of dermo-epidermal abnormalities. The average age of the patients was 53.2 years (range: 43-69 years; M:F ratio: 0.50). The control group consisted of 6 healthy subjects. The average duration of the post-phlebitis syndrome in the patients studied was 8.5 years. We excluded from the study patients in whom a central cause was identified as being responsible for the pathogenisis of the oedema of the lower limbs. In addition, patients with obliterant arteriopathy were also excluded. Venous pathology was evaluated first clinically and then investigated by continuous-wave Doppler. As a first step, venous pressure was measured by Doppler phlebomanometry in clino- and orthostatism. All patients underwent radioisotopic lymphoscintigraphy with microcolloids using the Rijke technique. Radioactivity was monitored by means of a computerized gamma-camera. We classified the pathological findings of radioisotopic lymphoscintigraphy as follows: 1) delayed transit; 2) obstacles; 3) star-shaped superficial collateral lymphatic circulations; 4) lymphocoele or cutaneous lakes. A significant difference was detected (p < 0.05) between the pressure values in the post- phlebitis lower limbs and the pressure values in normal subjects. Combining the results of our measurements we recorded delayed transit in 5 patients (69.5%). This latter group included the cases with the severest forms of post-phlebitis syndrome. Therefore, better knowledge of the pathophysiology of the lymphatic system would appear to be useful in order to understand the origin and evolution of oedema of the lower limbs of patients with post-phlebitis syndrome. To this end, radioisotopic lymphoscintigraphy may be useful as a first-level examination in order to evaluate the capacity and efficiency of the lymphatic system.

Adult↗
PubMedDate not supplied

[Clinical semeiology of the perforating veins in essential varicosis in the postphlebitic syndrome].

After a reminder of the anatomy of the perforating veins of the lower extremities and their physiopathology, various clinical aspects are presented. In the essential form of varicose veins disease, long saphenous refluxes are, at the beginning, responsible for stasis in the superficial venous system. During the course of the disease, it seems that the perforators become incontinent. In the post-phlebitic syndrome, the manifestations are different and there are numerous perforators, the topography of which depends on the location of the thrombosis. A well conducted clinical examination is absolutely necessary in order to demonstrate the origin of the long or short reflux, before the start of any treatment. In case of failure or recurrence, phlebography or varicography must be performed.

Humans↗
PubMed1994

[Site of phlebographically determined venous changes in postphlebitic syndrome with varicose ulcer].

In 207 legs with venous leg ulcers and postthrombotic syndrome proved by phlebography, the frequency of involvement of the 4 levels of deep venous system was assessed. Level A: deep veins of the lower leg. Level B: poplieal vein and gastrocranial veins. Level C: femoral veins. Level D: iliac veins. Our investigations showed that in 35% damages of the deep veins only in level A (lower leg) were responsible for venous ulcer. In cases with combinations of levels, Level A in 95% also was involved. One can say that postthrombotic leg ulcer correlates above all with the pathomorphological alterations of the lower leg veins.

Humans↗