Phlebologie最新文献

Color Doppler is a technique which performs a real-time opacification of the vascular system with blue indicating reverse flow and red indicating forward flow (directional color coding). In venous pathology, the use of color Doppler improves significantly the anatomical evaluation of the inferior vena cava, the iliac vein, the deep femoral vein, and the sural system. Color Doppler facilitates the study of deep venous thrombosis (providing useful information to differentiate ancient from most recent thrombus) and also the study of post-thrombotic conditions (assessment of reverse flow, repermeation phenomena). Finally, color Doppler produces a better insight for the study of varicose veins, especially with regard to mapping, identification of communicante veins, and study of the external saphenous vein.

A series of 1,000 patients has been studied. I. HEMATOMAE: They are nearly continuous during internal saphena stripping but depend on various parameters. 1) Anatomical: a) Varicose veins topography. Perforating veins. Perforating veins of the thigh cause haemorrhage but reactions of venous construction are quite important and precocious not to observe subcutaneous bleedings. More or less "soft" stripping creates a reaction of reflex vasoconstriction. Fore saphenous vein of the thigh Hematomae are more and more numerous and important because the fore saphenous vein is a vein whose wall is thinner, more fragile and almost more superficial. b) Type of patient. In an obese patient, hematoma seems to be more spectacular. In the thin patient, it appears faster, if hematic expression is too late. 2) Stripping techniques: It is possible to propose different techniques of stripping, but none of them can lower specifically post-surgical hematomae. 3) Anaesthesiae: a) General anaesthesia. A bilateral surgery under general anaesthesia was helpful to observe in some cases a less important hematoma at the level of the second operated leg. b) Rachi-anaesthesia. Physiological vasoconstriction requires a latent period for this kind of anaethesia which causes a vasomotor paralysis due to a blockade of the sympathetic nerve. c) Local anaesthesia. It is obtained by crural block in association with injection of Xylocaine Adrenalina at the level of perforating veins of the thigh. This technique causes less hematomae. II. ABSCESSES: Only 4 cases out of 1,000 operated legs have been reported. No related pathology have been observed particularly about lymphatic disorders (erysipelas or lymphoedema), no previous infection known which could not have explained such complications. Therapy was simple: incision at mid-thigh and draining by lamina. The patient recovered within two weeks.

For "redo" therapy in the popliteal space an excellent anatomical knowledge is imperative as shown by the results of the dissection of 38 cadaver legs. Dynamic phlebography is the only way to get this information. It is upon this examination that the phlebologist should make his choice either to use sclero-compression therapy or to reoperate the patient. In the case of an reoperation the external access should be chosen even if this implicates an anatomical challenge.

This procedure has been carried out on the bases of the most updated computer science technologies. This program aims at making use of the computer both as a storing and date processor instrument and as an examination aid with a visual result. Promed Phlebology makes it possible to carry out the test starting straight from the patients medical filing card. The storing system has been simplified at most, all the obliged steps being eliminated. The user will be able to choose the file according to his own needs, as well as avoid the intermediate steps by creating practical and synthetic files. This procedure allows enclosing of data to patient related images (photographs, instrumental text, X-rays, intraoperatory images, etc.), directly drawn by any video source (camera or still video camera). With this way, it is possible to use data storing to practical and statistical goals and to look quickly through the file.

It is possible for the stripper to go in a wrong direction during a stripping. This phenomenon occurs in two cases: it can go out of the lumen of the vein which is to strip (mainly perforations) or penetrate into another vein. The prevention of perforations depends on the quality of the stripper and that of the movement linked to various operations whose aim is to make its penetration easier when it "stumbles". The prevention of penetrations in another vein depends on the quality of the pre-operative cartography achieved by echo-Doppler under per-operative technical precautions.

The period of cicatrization of huge incisions of the leg, Lindon type, were verified in 181 surgeries. A quick cicatrization is obtained in 96% of surgeries whose aim is to resect varicose tissues massively or to ligate tibial perforating veins in sub- or supra-facial. On the other hand, post-hypodermectomy cicatrization for sclerosis of adipose tissue is much more tricky. It is often necessary to practice a resection of the atriophied skin, followed by a skin graft.