Phlebologie最新文献

Echo-sclerosis and phlebectomy are complementary. Thanks to them, it is possible to treat a post-surgical saphenous branch in a single session. Echo-sclerosis deals with the origin of the varicose vein, which is often deep in the panniculus adiposus, predilection area of this technique. Phlebectomy concerns the visible varicose segment. Complete erradication is achieved. Thanks to this complementary technique it is possible to gain a long-lasting result. Echo-sclerosis has treated the varicose vein upstream and phlebectomy downstream.

The writer invites us to compare the results obtained with echo-guided sclerotherapy with those obtained with "simple" sclerotherapy, the interest of which had already been shown. This study seems to be significative because an amount of 10% of positive results has been noticed. However it is only an intermediary study for the average treatment is only 18 months long. The careful supervision of the evolution of the sclerosed axis is also useful in the understanding of the importance of prescribing a complete and rigorous treatment whose aim is to increase the efficiency of the sclerosis of remaining varicose veins considerably as well as its quality and safety, on the cosmetic field.

67 cases of complications of superficial venous surgery of the lower limbs were reported. They consist in the following troubles: 23 arterious injuries, 10 venous injuries, 28 nervous injuries, 4 instrument forgettings, at last, 2 anaesthesia incidents. All these injuries lead to: 4 deaths, 9 amputations, and in 75% of cases, important functional after-effects. One has to insist on the necessity of per-surgical vigilance with the immediate therapy of injuries that have been observed. It is also necessary to look carefully after the patient during the surgery. The disrespect of these precautions is often followed by the most important complications we had to face.

The study concerned 106 superficial venous thrombosis (SVT) diagnosed thanks to an echo-Doppler, between october 1989 and february 1993 in 42 men and 63 women aged 59 +/- 18 years and 64 +/- 18 years respectively. In nearly half cases, clinical sign was a suspicion of a deep venous thrombosis (DVT) (34 cases) or a pulmonary embolism (PE) (14 cases). A supposed precipitating factor was found in 65 cases out of 105: a cancer already known in 11 cases. The SVT was located in the left lower limb in 56 cases, in the right lower limb in 41 cases and a bilateral one in 9 cases. The long saphenous vein was affected in 60 cases, the short saphenous vein in 22 cases, both saphenous veins in 6 cases and a non-collateral saphenous vein in 17 cases. In 38 cases, a DVT added to a SVT, either separately in 19 cases, 9 of which in controlateral or by proximity extension from an arch in 7 cases or from a more distal perforating vein in 8 cases. In total, complications, either DVT or SVT, appeared in 46 cases out of 105. The age of > or = 60 has been associated with the presence of complications. In 3 cases, a cancer was discovered in the month following the SVT. These results question the benignancy of SVT. They match those of two series of SVT diagnosed thanks to echo-Doppler and recently reported. They urge to explore systematically both venous networks, superficial and deep and to achieve an etiologic balance either for SVT or unexplained DVT.

Indications for duplex scan in venous surgery. Vascular surgeons are led to request Duplex Scan examination of patients with chronic venous insufficiency in a number of circumstances: A) To obtain information supporting the diagnosis and treatment plan: Chronic venous insufficiency may be due to isolated superficial venous insufficiency or (and) deep venous insufficiency (post-thrombotic syndrome, primary deep valvular insufficiency, congenital malformation). In practice, Duplex Scan examination of the deep venous system is indicated whenever the patient's history is suggestive of deep venous thrombosis or the clinical status is stage 2 or 3 (Ad Hoc Committee classification). In patients with reflux in the popliteal fossa, Duplex Scan is helpful because physical examination and Doppler cannot correctly differentiate short saphenous insufficiency, gastrocnemius insufficiency and reflux in the popliteal-tibial axis, especially as these physiopathologic mechanisms may be associated. In patients with atypical varices, Duplex Scan can demonstrate: Absence of reflux in the greater saphenous vein-femoral vein termination or the short saphenous vein-popliteal vein termination. Varices in the lateral or posterior thigh. In patients with varicose vein thrombosis, Duplex Scan can reveal: The extent of any association with deep venous system. The extent of superficial venous thrombosis. When the results of varicose vein surgery are unsatisfactory, Duplex Scan can determine whether a redo surgery is justified: Persistence of a major leak between the deep and superficial venous system usually prompts redo surgery. Less often, recurrence is due to primary deep valvular insufficiency, in which case valvuloplasty may be indicated.(ABSTRACT TRUNCATED AT 250 WORDS)

Introduction: Lymphatic injuries are unavoidable during varicose vein surgery. However these injuries seldom lead to complications. This study was held to try to find an explanation to this contradiction which seems to be only noticeable.

Material and method: If anatomy shows that it is impossible to operate on varicose veins without injuring lymphatic vessels, the regeneration power of these latters, known for a long time, is such that complications due to these injuries are all the more exceptional that surgeries are less traumatizing than it used to be. Nowadays, each surgeon is only faced to a small number of such complications during their career. This rareness makes a methodical personal study quasi-impossible. That is why we sent a questionnaire to about thirty surgeons specialized in this field. This questionnaire, about their experience, dealt with lymphatic complications they had met during varicose veins surgery.

Results: Twenty three answers were sent in time and deal with more than 184,000 surgeries. The lymphatic complication rate is about 8.7%, 5.4% of which are lymphorrhea, 2.6% of lymphocele, 1.09% of lymphangitis and 0.5% of lymphoedema. Of course, these figures are approximate. Lymphoedema is the only long-lasting lymphatic complication of the varicose veins surgery.

Conclusions: According to us, sclerotherapy seems to be more effective than surgery, in case of signs, even benign, of lymphatic insufficiency.

Post-surgical erectile dysfunctions of superficial veins of the lower limbs are seldom reported. It seems to be due to the fact that they are ignored. In most cases, one has to find their origins in an abnormality of arterious distribution towards sexual parts: one or several of these latters come from common femoral veins and their colaterals (the external pudendal arteries) and not from hypogastrics (and internal sexual arteries). Therefore, it is necessary to take care of external sexual arteries during Scarpa's dissections in male patients in order to avoid the possible occurrence of a partial secondary or total impotency.

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.