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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Before describing the various treatments of these ulcers, the author discusses their etiological process. He emphasizes that superficial venous insufficiency is the result of a deep venous insufficiency which alters and deteriorate the cellular metabolism. In fact, the chronic hypertension is transmitted to the capillary network, often with irreversible consequences. The author analyzes the healing process: inflammatory phase followed after 2 weeks by the appearance of fibroblasts, wound contraction and epithelialization. The third phase, so-called stabilization phase, lasts between 6 and 12 months. The treatment varies according to the etiology. It is mostly a matter of experience in order to avoid allergenic treatments.
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PMID:[Treatment of intractable venous ulcer]. 219 48

In this retrospective study, distal hyperirrigation syndrome was identified by "irrigraphy", a functional exploration method used to define an irrigation index at various levels of the lower limbs as determined by pulse wave amplitude, heart rare and segmental resistances. In 47 lower limbs studied, there were 26 unequivocal, 14 relative and 7 "masked" hyperirrigations. The main etiology was diabetes (24 limbs), but the syndrome was also noted in cases of peripheral neuropathy and chronic venous insufficiency. There was no basic difference between unequivocal and relative hyperirrigations. Some hyperirrigation states were not apparent in irrigraphy because of arterial lesions on upstream axes. The syndrome was also observed in approximately the same number of cases in insulin-dependent and noninsulin-dependent diabetes. The clinical disorders observed were especially peripheral trophic ones, notably perforating ulcers of the foot or various ulcers. Changes in the irrigraphic profile were followed regularly in 20 limbs. The rise in distal irrigation indices was due to a drop in peripheral resistances related to an abnormal opening up of arteriovenous anastomoses. A state of spontaneous sympathectomy was thus constituted, particularly in diabetic patients. The process was similar in syndromes of neurologic origin and in venous stasis. The mechanism was local, with venous hypertension causing the opening up of arteriovenous shunts. However, microangiopathic lesions must also be taken into account, since they can cause or favor arteriovenous shunting. The opening up of arteriovenous anastomoses is in effect the element common to all syndromes of distal hyperirrigation of various origins.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Distal hyperirrigation syndrome. Clinical and physiopathological aspects]. 228 13

The methods to block the venous drainage of the spongy bodies (ligation, arterialization and embolization of the venous system in the penis) used in the treatment of vascular erectile impotence lead to spongy tissue sclerosis. The pathogenetic unfoundedness of the above methods prompted the authors to develop better methods for treating the venous insufficiency of the spongy bodies. Nineteen patients with erectile impotence were examined by using drug (papaverin), induced erection, dynamic spongiography, cavernography, and spongiobiopsy. The examination provided a classification of venous insufficiency in the spongy bodies, which included 3 types of the disease: distal, proximal, and mixed. For the treatment of the distal pattern, a new surgical method was developed, namely, immersion of the deep dorsal vein of the penis into the duplication of the tunica albuginea in the spongy bodies. The method partially blocks the venous drainage only in the erected penis, thus avoiding persistent venous hypertension in the erected penis, thus avoiding persistent venous hypertension in the spongy bodies. Five patients were operated on. The follow-up of 3 months to 1 year showed an improvement of penis erectility. Lower venous drainage in the spongy bodies was evidenced by Doppler sonography and perfusion artificial erection. Thus, the proposed operation is an effective tool to correct venous drainage in the spongy bodies.
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PMID:[Embedding of the deep dorsal vein into the duplication of the tunica albuginea--a new method for the surgical treatment of venous insufficiency of the corpora cavernosa penis]. 239 45

Based on a retrospective evaluation of 107 patients with congenital venous angiodysplasia of the Type Klippel-Trenaunay (n = 76) and Type Servelle-Martorell (n = 31) the frequency and pathogenesis of aneurysm formation in the venous system has been analysed. The vascular patterns include both cylindric ectasias and fusiform aneurysms with an incidence of approximately 40%. Preferred locations are subcutaneous drainage veins, the popliteal, external iliac vein and atypic communicating veins between the superficial and the deep venous system. Complications of the aneurysm such as local thrombosis, recurrent pulmonary embolism or bleeding from rupture were not observed. From a pathogenetic point of view the aneurysm formation in venous angiodysplasias results probably from two causative factors, i.e., a congenital weakness of the venous wall (inborn error?) and an abnormal hemodynamical stress situation. The latter is caused by concomitant malformations of the deep venous system (avalvulia, hypo- and/or aplasia). The persistent intermittent venous hypertension associated with a more or less pronounced increase of the venous volume in the affected venous system of the limb results in a deep venous insufficiency respectively venous reflux disease. Surgery is indicated under two conditions: a) in the presence of aneurysm complications or b) for the elimination of a pathological short circuit flow in some drainage veins. Antireflux surgery, e.g., venous valve transfer form the brachial vein, is up to recently still in a stage of experimental-clinical investigation. The therapy of choice is predominantly conservative, i.e., external compression bandages or stockings to reduce the deleterious effects of a chronic deep venous insufficiency respectively venous reflux disease.
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PMID:[Aneurysmic transformation of the venous system in venous angiodysplasias of the limbs]. 254 55

It has been demonstrated that skin blood flow of postphlebitic limbs is increased. Also the venoarteriolar response (VAR), i.e. precapillary vasoconstriction present in normal limbs on standing up, is reduced in limbs with venous insufficiency, resulting in capillary hypertension. The supine skin resting flow (SF) and the skin flow on standing (SF) have been measured with laser-Doppler in 30 normal lower limbs and 70 postphlebitic limbs with ambulatory venous pressure greater than 65 mmHg; also, the rate of ankle swelling (RAS) has been measured with strain-gauge plethysmography. The VAR was derived from VAR = 100* (RF-SF)/RF. The reduction of VAR and the increase in SF, which has been demonstrated in the postphlebitic limbs, correlated well with the rate of ankle swelling (RAS). The measurements of SF, VAR and RAS evaluate objectively the degree of impairment of the microcirculation because of severe venous disease. They offer the possibility to study the natural history and the effect of treatment of venous hypertensive microangiopathy.
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PMID:Skin flow and swelling in post-phlebitic limbs. 266 73

The diagnosis of varicose veins is based on historical details pertaining to risk factors such as familial preponderance, advanced age, overweight, multiple births, professional activities carried out mainly in the standing or sitting position, use of oral contraceptives, diuretics or drugs which lower venous tone. Swelling of the legs on prolonged recumbancy, during pregnancy, fractures or cast treatment may be associated with thrombosis (Table 1). In addition to inspection and palpation in the standing and lying positions, the status of the pulses and the joints are of importance. The diagnostic measures must clarify the stage of the chronic venous insufficiency and provide adequate information on the various forms of venous functional disturbances (Table 2). Classification of varicose veins is carried out according to etiology--primary or secondary--or according to anatomical and functional derangement: with varicosities of the great saphenous vein and the lesser saphenous vein, in addition to valve incompetence at the proximal confluence of the saphenous-femoral junction, there may be segmental or global valve incompetence frequently in combination with a perforating vein incompetence. Varicosities of the great saphenous vein are classified with respect to whether the venous valves involved are those only in the region of the proximal confluence or from the inguinal region to above or below the knee or to the ankle, respectively, in four degrees of severity (Figure 1). For varicosities of the lesser saphenous vein, three degrees of severity are differentiated, the confluence incompetence, incompetence of the venous valves from the knee to the middle of the lower leg or from the knee to the ankle.4+ as the postthrombotic syndrome. Chronic venous insufficiency is characterized by venous hypertension and subdivided into three degrees of severity: grade I in the presence of corona phlebectatica paraplantaris and stasis edema; grade II in the presence of hyperpigmentation, melanodermitis, atrophy blanche, stasis induration and hypodermitis; grade III in the presence of hyperpigmentation, melanodermitis, atrophy blanche, stasis induration and hypodermitis; grade III in the presence of healed or florid ulceration. The two most important diagnostic measures are Doppler ultrasonography and ascending pressure phlebography which complement each other (Table 3)...
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PMID:[Diagnosis and surgical management of varicosities]. 268 Aug 50

It is known that deep venous thrombosis (DVT) of the ilio-femoro-popliteal axis is frequently associated with irreversible damage to valvular competence of the veins and consequently with varying degrees of chronic venous insufficiency. Because preservation of the valvular function of deep veins can play an important role in preventing the postphlebitic syndrome we analysed and compared the long-term functional outcome of two equally large cohorts of patients treated either surgically for restoration of venous patency and valvular function (24 patients) or medically with heparin, oral anticoagulants and compression stockings (25 patients). The study was also intended to examine the impact of duration and extent of DVT as predictive factors of late outcome. Follow-up time was 7.6 and 7.9 years respectively, operative mortality nil. Assessment of venous function was based on clinical observations as well as on measurement of haemodynamic parameters. Non-fatal pulmonary embolism after onset of treatment occurred in both cohorts with an equal frequency of 13%. Patients operated on for ilio-femoral DVT were with few exceptions totally independent of any form of adjunctive hosiery which was in sharp contrast to the conservatively managed group. If onset of DVT had occurred more than 3 days earlier and extended from the ilio-femoral axis to the popliteo-crural level, surgery usually failed and patients were no better off than in the comparable medical group. The same pattern of late outcome was found for all other clinical and haemodynamic parameters; i.e. clinical signs of venous hypertension, valvular competence as judged by sonography, patient's self-assessment and the expelled volume and refilling time measured by dynamic plethysmography after standardised leg work. The mean expelled volume was 1.1 +/- 0.5 ml/100 g/min. for the surgical group treated early for ilio-femoral DVT and 0.7 +/- 0.5 ml/100 g/min for the corresponding medical group (P = 0.05). Recovery or refilling time was 50 +/- 21 s for the surgical group and 28 +/- 26 s for the medical group (P = 0.03). Thus, the clinical and haemodynamic effect of surgical thrombectomy was significantly superior to conservative management in ilio-femoral thrombosis treated within 3 days. For extensive thrombosis treated early the advantage of surgical thrombectomy was also evident, but the difference between the two treatment groups was not significant. The advantage of surgery was however totally lost in patients operated on for extensive DVT of long duration (i.e. greater than 3 days).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Surgical thrombectomy versus conservative treatment for deep venous thrombosis; functional comparison of long-term results. 239 84

There has been considerable interest in the management of injured extremity veins since the American experience during the Vietnam War. Fortunately, there are an increasing number of reports from civilian experience in the United States that add valuable information. Although the controversy continues, it appears that there is merit in repair of many injured lower-extremity veins, particularly the popliteal vein when it is a single return conduit, assuming that the patient's general condition will permit, in an attempt to prevent acute venous hypertension initially and chronic venous hypertension subsequently. Figure 1 identifies the recovery potential that exists even if the initial venous repair fails. In contrast to thrombosis in the arterial system, recanalization is the rule in venous thrombosis. Patent valves can exist above and below the rather localized area of thrombosis. It appears that recanalization will prevent the problems of chronic venous insufficiency. It is obvious that many patients do well for years; however, the sequelae of acute venous hypertension may be more demonstrable after 10 or 15 years. There has not been similar evidence supporting a more aggressive approach in general in upper-extremity veins. However, it should be appreciated that a return pathway must remain patent, as noted in replantation of extremities. Obviously, there are differences in military and civilian wounds, with the former usually having more extensive soft-tissue destruction and obliteration of collateral veins and lymphatic channels. Unfortunately, many civilian gunshot wounds are being seen in the United States that are similar to the military type. We must not forget the lessons of the past, and we must continue to analyze our experience in the management of injured veins under a variety of conditions.
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PMID:Management of venous trauma. 304 7

Chronic venous insufficiency is a pathologic condition of the skin and subcutaneous tissues in the lower extremity caused by stasis of the blood flow. Incompetency or failure of the venous valves results in reflux and ambulatory venous hypertension, which is more severe with deep than with superficial venous incompetency. Superficial chronic venous insufficiency (varicose veins) is effectively managed with ligation and stripping of incompetent perforator and superficial veins to restore normal venous physiology. Deep chronic venous insufficiency (postphlebitic leg) presents a widespread pathologic disorder that is refractory to surgical correction. Adjunctive surgical measures such as removal of incompetent perforators or superficial veins to lessen local stasis or skin grafting of ulcers are often indicated in selected cases. The underlying chronic venous insufficiency requires management with elastic compression, elevation of the legs, and exercise for best results.
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PMID:Surgical management of chronic venous insufficiency. 305 27

The mechanism by which chronic venous insufficiency and venous hypertension are associated with ulceration of the legs is not yet understood. To investigate this mechanism further accumulation of white cells in the dependent legs of normal volunteers, patients awaiting surgery for simple varicose veins, and patients with chronic venous insufficiency was studied. About 24% fewer white cells than in normal subjects left the dependent foot of patients with venous hypertension, and this trapping of white cells, was reversed when the foot was raised; similar changes were not observed in normal subjects or patients with varicose veins. The trophic skin changes typically seen in patients with venous hypertension may be aggravated by damage caused by the repeated accumulation of white cells in the microcirculation.
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PMID:White cell accumulation in dependent legs of patients with venous hypertension: a possible mechanism for trophic changes in the skin. 313 81


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