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PubMedDate not supplied

[General physiopathology of postphlebitic syndromes].

The physiopathological analysis of post-phlebitic disorders enables us to throw light upon several pathogenic mechanisms. With regard to physiopathology it is possible to distinguish: the obstructive syndrome, linked with the obstruction of a large venous collector; the supply syndrome: post-phlebitic superficial venous deficiency; the repermeation syndrome: post-phlebitic deep venous deficiency; the restrictive syndrome, characterized by the deterioration of the venous distensibility; mixed syndromes in which various pathogenic mechanisms are involved. These various pathological processes eventually result in a state of chronic venous stasis, characterized at the microcirculatory level by the triggering- off of a series of vicious circles which are at the root of a real tissular illness, added to which are the trophic disorders which cause the illness to be serious.

Femoral Vein↗
PubMedDate not supplied

[Clinical study of the postphlebitic syndrome].

The syndrome is approached from the diagnostic and developmental point of view. The clinical examination remains of paramount importance, for it is necessary to differentiate between the primary varices and the post-phlebitic varices which have the same functional symptoms. The main trophic complications are listed, principally: oedema, hypodermititis, ochrodermititis and leg ulceration, which is the most formidable complication and which still occurs very frequently. Ulceration is likely to occur more frequently following sural phlebites rather than those higher up. The main topographical areas of varices are described, without forgetting the collateral circulation in the abdominal and subpudendal region. The developmental aspect of post-phlebitic syndrome is difficult to predict as sequels appear after varying lengths of time, and in varying ways. Finally, venous functional investigations have a practical advantage. They make it possible to assess the functional state of the limb by indicating precisely the state of the deep and superficial circulation. They can thus make it possible to assess the importance of venous stasis and the nutritional state of the tissues.

Humans↗
PubMedDate not supplied

[Constriction: results of Lymphapress in edematous forms of the postphlebitic syndrome].

Constraint is the major treatment for post-phlebitic syndrome. Use of Lymphapress improves constraint treatment for certain complicated forms of post-thrombotic syndrome, especially edematous forms with associated panniculitis. Treatment using Lymphapress is non-traumatic for the patient and produces an improved condition in 80% of the cases.

Bandages↗
PubMedDate not supplied

[The value of heparin in postphlebitic syndromes].

Post-phlebitic syndromes, the result of late diagnosis at the acute stage and/or inappropriate treatment, are disorders which are still very widespread, chronic, and more or less incapacitating. For fifty years, there has been no new really and lastingly active medication to improve the local condition and check the aggravation. However, heparin is still the least ineffectual form of medication. Applied in series of treatment of 10/15 days, preferably by route IV, it alone is able to produce consistently fair results. Taken on average with the application precautions, the risks with standard doses are practically nil.

Chronic Disease↗
PubMedDate not supplied

[Classical treatment of trophic disorders in the postphlebitic syndrome].

The author emphasizes firstly the primordial importance of prevention at each stage of thromboembolic illness, before, during, and after phlebitis; he also emphasizes the necessity of the most rigorous possible treatment of the acute phase (elastic support, ambulation, sufficiently prolonged anticoagulation, early thermal cure). Next the author explains the classical treatment of trophic complications (oedema, hypodermitites, dermoepidermic lesions, ulcers) which must be implemented according to a rational plan, and particularly with regard to leg-ulcers, for which the elastic support plays a leading part. Finally, the regulation of hygiene and regular checking should limit to the maximum the extent and worsening of the complications.

Anticoagulants↗
PubMedDate not supplied

[Thermal treatment of postphlebitic syndromes].

Post-phlebitic illness, characterised by its great clinical polymorphism, justifies crenotherapy: in the months following thrombotic accident, as soon as possible, in order to get rid of functional and oedemic sequels, and articular stiffness in some cases. At this stage one can hope to check the development of the illness and delay the occurrence of complications; later, if trophic disorders set in, and especially at the constitution of sclero-inflammatory or sclerous hypodermitites. The ulcer not being a contra-indication. In all cases, crenotherapy has a remarkable and lasting effect on functional symptoms.

Adult↗
PubMedDate not supplied

[Does hypodermectomy have a role in surgery for postphlebitic syndrome?].

The fibrosis of the hypodermis in the lower part of the leg is a sign of venous stasis. But it appears in various forms. One is diffuse, circular, atrophic sclerosis, in a patch, occurring frequently in old post-thrombotic syndromes, another is sclerous hypodermititis in plaque form, submalleolar, well circumscribed and without aetiopathogenic links with deep venous thrombosis. This latter form is the only one to respond favorably to surgical resection.

Adult↗
PubMed2000

Outcome of pediatric thromboembolic disease: a report from the Canadian Childhood Thrombophilia Registry.

The outcome for children with deep vein thrombosis (DVT) and pulmonary embolism (PE) is unknown. An understanding of morbidity and mortality of DVT/PE is crucial to the development of rational treatment protocols. The Canadian Childhood Thrombophilia Registry has followed 405 children aged 1 mo to 18 y with DVT/PE for a mean of 2.86 y (range, 2 wk to 6 y) to assess outcome. The all-cause mortality was 65 of 405 children (16%). Mortality directly attributable to DVT/PE occurred in nine children (2.2%), all of whom had central venous line-associated thrombosis. Morbidity was substantial, with 33 children (8.1%) having recurrent thrombosis, and 50 children (12.4%) having postphlebitic syndrome. Recurrent thrombosis and postphlebitic syndrome were more common in older children, although deaths occurred equally in all age groups. The incidence of recurrent thrombosis and postphlebitic syndrome are likely underestimated because of difficulties in diagnosis, especially in younger children. The significant mortality and morbidity found in our study supports the need for international multicenter randomized clinical trials to determine optimal prophylactic and therapeutic treatment for children with DVT/PE.

Adolescent↗
PubMed2003

Deep venous thrombosis during pregnancy and after delivery: indications for and results of thrombectomy.

PURPOSE: Pregnancy and the puerperium are time periods of an increased risk for venous thromboembolism. An ideal treatment should lead to complete restoration of the venous lumen, elimination of the embolic source, and prevention of severe postphlebitic syndrome. Anticoagulation therapy with heparin or thrombectomy are treatment options. In the current literature, these options are discussed controversially. METHODS: From January 1982 to December 2001, 97 women underwent (93% transfemoral) thrombectomy and construction of an arteriovenous fistula (AVF) for deep venous thrombosis related to pregnancy. The clinical and coagulation parameters were evaluated. The AVF was ligated 3 to 6 months later. Follow-up with duplex ultrasound scan, photoplethysmography, and strain-gauge plethysmography was completed in 87 women. RESULTS: Surgery was performed without any maternal death or pulmonary embolization. A cesarean section was carried out during the same anesthesia in 11 cases. Thrombectomy was completed with construction of a temporary AVF in 90 patients (92.8%). One fetal death occurred in the recovery room for unknown reasons. In the early postoperative course, 16 patients (16.5%) underwent redo surgery for rethrombosis with or without the occlusion of the fistula. In 14 of these patients, the venous system remained patent thereafter. Fetal or neonatal death occurred in five cases 2 to 10 weeks after surgery, mainly because of abruption of the placenta probably from anticoagulation. Among 247 preoperatively occluded anatomic regions, 221 could be restored, and the secondary patency rate amounted to 89.5%. After a mean follow-up period of 6 years, 49 patients (56.3%) were seen without a postphlebitic syndrome, and only three patients (3.5%) had had a leg ulcer develop. CONCLUSION: In experienced hands, venous thrombectomy is a safe method to prevent pulmonary embolism and postphlebitic syndrome in women during pregnancy and the puerperium. The frequency of a severe postphlebitic syndrome after our surgical approach is lower than the rates published for anticoagulation treatment alone.

Abruptio Placentae↗