Druckgradient in den Beinvenen während der Betätigung der Wadenpumpe

VASA ◽  
2000 ◽  
Vol 29 (3) ◽  
pp. 187-190 ◽  
Author(s):  
Cestmir Recek ◽  
Pojer
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Standing Position ◽  
Quiet Standing ◽  
High Ligation ◽  
Long Saphenous Vein ◽  
Primary Varicose Veins ◽  
Reflux Recurrence

Background: Neovascularization is an important cause of venous reflux recurrence after high ligation of the long saphenous vein. The pathogenesis of this phenomenon is so far obscure. It is possible that a hemodynamic factor – a pressure gradient between the femoral vein and the residual long saphenous vein – could be the trigger initiating the process of neovascularization. Patients and methods: Venous pressure measurements on eight patients with primary varicose veins were performed in the erect position in the insufficient long saphenous vein on the thigh. Mean pressures in the quiet standing position and ambulatory pressures were considered. By interrupting the saphenous reflux either distally or proximally to the point of measurement the pressure conditions either in the femoral or in the crural veins were simulated. Results: With the tourniquet placed distally to the point of measurement, the venous pressure in the upper interrupted segment of the long saphenous vein (equivalent to the pressure in the femoral vein) remained uninfluenced during ambulation. In contrast, by interrupting the reflux proximally to the point of measurement, a marked decrease of the ambulatory pressure in the lower part of the long saphenous vein (equivalent to the pressure in the crural veins) was noted. Conclusions: A pressure difference occurs between the veins of the thigh and the lower leg during the activation of the muscle venous pump. This fact may explain the tendency of recurrencies of varicose veins after high ligation of the long saphenous vein as well as the initiation of reflux.

Haemodynamic Correction of Varicose Veins (CHIVA): An Effective Treatment?

1996 ◽  
Vol 11 (3) ◽  
pp. 98-101 ◽  
Author(s):  
P. Zamboni ◽  
C.V. Feo ◽  
M. G. Marcellino ◽  
G. Vasquez ◽  
C. Mari
Keyword(s):  
Saphenous Vein ◽  
Continuous Wave ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Vein Thrombosis ◽  
Long Saphenous Vein ◽  
Group A ◽  
Primary Varicose Veins ◽  
Short Saphenous Vein ◽  
Group B

Objective: Evaluation of the feasibility and utility of haemodynamic correction of primary varicose veins (French acronym: CHIVA). Design: Prospective, single patient group study. Setting: Department of Surgery, University of Ferrara, Italy (teaching hospital). Patients: Fifty-five patients with primary varicose veins and a normal deep venous system (ultrasonographic criteria) were studied. Interventions: Fifty-five haemodynamic corrections by the CHIVA method described by Franceschi were undertaken. Seven patients were treated for short saphenous vein varices (group A) while 48 patients were treated for long saphenous vein varices (group B). Main outcome measures: Clinical: presence of varices and reduction in symptoms. Duplex and continuous-wave Doppler detection of re-entry through the perforators and identification of recurrences or new sites of reflux. Postoperative ambulatory venous pressure and refilling time measurements. Patients were studied for 3 years following surgery. Results: In group A, 57% short saphenous vein occlusions with no re-entry through the gastrocnemius and soleal veins were recorded. In group B the long saphenous vein thrombosis rate was 10%. In this group 15% of the patients showed persistence of reflux instead of re-entry at the perforators. Early recurrences were also observed. Overall CHIVA gave excellent results in 78% of the patients. Statistically significant ambulatory venous pressure and refilling time changes were recorded ( p<0.001). Conclusions: CHIVA treatment is inadvisable for short saphenous vein varices. Long saphenous vein postoperative thrombosis is related to development of recurrences

Femoral vein valve incompetence as a risk factor for junctional recurrence

2017 ◽  
Vol 33 (3) ◽  
pp. 206-212 ◽  
Author(s):  
Sergio Gianesini ◽  
Savino Occhionorelli ◽  
Erica Menegatti ◽  
Anna Maria Malagoni ◽  
Mirko Tessari ◽  
...  
Keyword(s):  
Risk Factor ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Recurrence Risk ◽  
High Ligation ◽  
Frequent Event ◽  
Operative Assessment ◽  
Reflux Recurrence

Background Recurrent varicose veins occur up to 80% of procedures. The sapheno-femoral junction can be involved in more than 50% of cases. A detailed pathophysiological explanation of the phenomenon is still missing. The aim of the present work is to evaluate the role of femoral vein incompetence as risk factor for sapheno-femoral junction recurrence. Methods Three-hundred-eighty-one patients presenting an incompetent great saphenous vein system and eventually also an incompetent femoral tract (C2-6EpAsdPr) underwent a great saphenous vein high ligation with flush ligation also of the incompetent tributaries along the leg, sparing the saphenous trunk. Pre-operatively, all patients underwent a sonographic evaluation assessing the superficial and deep venous systems, including a detailed analysis of the iliac-femoral vein tract above the sapheno-femoral junction. A retrospective statistical analysis assessed the recurrence risk associated with iliac-femoral vein tract incompetence. Results In a 5.5 ± 1.9 years follow-up, great saphenous vein trunk reflux recurrence was detected in 45/381 (11.8%) cases. The reflux source was found in a reconnected sapheno-femoral stump in 11/45 cases (24.5%), in the pelvic network in 8/45 cases (17.8%), in a neovascularization process in 7/45 (15.5%) and in a newly incompetent great saphenous vein tributary in 19/45 (42.2%). At the pre-operative assessment, iliac-femoral vein tract reflux was present in 7 (26.9%) of the 26 cases who developed a sapheno-femoral junction recurrence and in 25 (7%) of the 355 patients who did not demonstrate sapheno-femoral junction recurrence (odds ratio: 4.8; confidence interval 95%: 1.8–12.6; p < .003). Discussion Despite many technical diagnostic and therapeutic refinements, varicose veins recurrence remains a frequent event. The present investigation points out the association among iliac-femoral vein tract incompetence and sapheno-femoral junction recurrences after high ligation.

Venous pressure gradients in the lower extremity and the hemodynamic consequences

VASA ◽  
2010 ◽  
Vol 39 (4) ◽  
pp. 292-297 ◽  
Author(s):  
Recek
Keyword(s):  
Saphenous Vein ◽  
Pressure Difference ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Lower Leg ◽  
High Ligation ◽  
Venous Reflux ◽  
Pump Activity

Pressure differences play an important role in the hemodynamics of both arterial and venous circulation. Venous ambulatory pressure gradient of about 35 mm Hg arises during the activity of the calf muscle venous pump between the veins in the thigh and the lower leg; this is the initiator launching venous reflux in varicose vein patients. The hemodynamic consequence of venous reflux is interference with the physiological decrease in venous pressure in the lower leg and foot and the occurrence of ambulatory venous hypertension, the degree of which depends on the magnitude of refluxing blood. Pressure difference occurring between the femoral vein and the remnant of great saphenous vein after high ligation or crossectomy during calf pump activity may be the activator of the process leading to the building of new venous communicating channels, the consequence of which is recurrent reflux. Neovascularization is apparently triggered by this hemodynamic factor, not by the surgical procedure itself, because neovascularization does not occur after harvesting of the great saphenous vein in the groin in people without varicose veins. Venous pressure potentials developing in the lower leg during the calf pump activity force the blood to flow from deep into superficial veins during muscle contraction and in the opposite direction during muscle relaxation. An untoward event caused by venous pressure difference is presented - spontaneous bypassing of a competent valve in the saphenous remnant after crossectomy, which converted a favourable hemodynamic situation into a harmful one. Possible explanation of this undesirable event is offered.

Invasive therapeutic options in truncal varicosity of the great saphenous vein

VASA ◽  
2006 ◽  
Vol 35 (3) ◽  
pp. 157-166 ◽  
Author(s):  
Hach-Wunderle ◽  
Hach
Keyword(s):  
Minimally Invasive ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Stage Iii ◽  
High Ligation ◽  
Surgical Trauma ◽  
Disease Stages

It is known from current pathophysiology that disease stages I and II of truncal varicosity of the great saphenous vein do not cause changes in venous pressure on dynamic phlebodynamometry. This is possibly also the case for mild cases of the disease in stage III. In pronounced cases of stage III and all cases of stage IV, however, venous hypertension occurs which triggers the symptoms of secondary deep venous insufficiency and all the complications of chronic venous insufficiency. From these facts the therapeutic consequence is inferred that in stages I and II and perhaps also in very mild cases of stage III disease, it is enough "merely" to remove varicose veins without expecting there to be any other serious complications in the patient’s further life caused by the varicosity. Recurrence rates are not included in this analysis. In marked cases of disease stages III and IV of the great saphenous vein, however, secondary deep venous insufficiency is to be expected sooner or later. The classical operation with saphenofemoral high ligation ("crossectomy") and stripping strictly adheres to the recognized pathophysiologic principles. It also takes into account in the greatest detail aspects of minimally invasive surgery and esthetics. In the past few years, developments have been advanced to further minimize surgical trauma and to replace the stripping maneuver using occlusion of the trunk vein which is left in place. Obliteration of the vessel is subsequently performed via transmission of energy through an inserted catheter. This includes the techniques of radiofrequency ablation and endovenous laser treatment. High ligation is not performed as a matter of principle. In a similar way, sclerotherapy using microfoam is minimally invasive in character. All these procedures may be indicated for disease stages I and II, and with reservations also in mild forms of stage III disease. Perhaps high ligation previously constituted overtreatment in some cases. Targeted studies are still needed to prove whether secondary deep venous insufficiency can be avoided in advanced stages of varicose vein disease without high ligation and thus without exclusion of the whole recirculation circuit.

Plication of the Sapheno–Femoral Junction: Effects on Incompetence after Two Years

1991 ◽  
Vol 6 (3) ◽  
pp. 159-165 ◽  
Author(s):  
Giovanni V. Belcaro
Keyword(s):  
Coronary Artery ◽  
Saphenous Vein ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Signs And Symptoms ◽  
Long Term Results ◽  
Pressure Measurements ◽  
Venous Reflux ◽  
Long Saphenous Vein

Plication of the long saphenous vein at the sapheno–femoral junction (SFJ) is an alternative to flush ligation and stripping. This technique abolishes reflux at the SFJ without altering the vein; this may then be used for arterial surgery or coronary artery grafting. Candidates for plication were selected on the basis of ambulatory venous pressure measurements and duplex scanning. These tests indicate and quantify the degree of superficial venous incompetence. Plication of the SFJ reduces the calibre of the vein to 60–70% for a length of 1.5 cm, allowing the value cusps to close when flow in the femoral vein is reversed. In this study 20 limbs were evaluated (in 20 patients) 6, 12 and 24 months after plication. Venous reflux was significantly reduced and there was an improvement in signs and symptoms. Thus, SFJ plication seems to be an effective physiological alternative to flush ligation in some subjects. However, long-term results (> 5 years) must be still evaluated.

scholarly journals The measurement of venous pressure by Doppler: is it a hemodynamic evaluation ?

2020 ◽  
Vol 5 (2) ◽  
Author(s):  
Pier Luigi Antignani ◽  
Giampiero Peruzzi ◽  
Tommaso Spina
Keyword(s):  
Clinical Application ◽  
Saphenous Vein ◽  
Normal Values ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Average Pressure ◽  
Doppler Method ◽  
Vein Thrombosis ◽  
Posterior Tibial ◽  
Long Saphenous Vein

Since 1980 using the Doppler method, planned by Bartolo, we have studied several patients by means of the measurement of venous pressures, both in orthostatism and in clinostatism. In a normal subject, in orthostatism the value of average pressure is 60 mmHg in the posterior tibial vein, and 60 mmHg in the long saphenous vein. When there are varicose veins, the average pressure is 90 and 96 mmHg respectively in the deep veins and in the superficial ones. In the case of post-thrombotic syndrome, the average values are 101 and 102 mmHg in the deep and superficial veins, respectively. In clinostatism, the normal values are under 20 mmHg and in subjects with vein thrombosis the value increase to 30 mmHg and more. After more than 30 years we discuss the reliability of the method, the hemodynamic basis and its clinical application in phlebological practice.

scholarly journals Primary varicose veins: Frequency, clinical significance and surgical treatment

2004 ◽  
Vol 132 (11-12) ◽  
pp. 398-403
Author(s):  
Dragan Vasic ◽  
Lazar Davidovic ◽  
Zivan Maksimovic ◽  
Aleksandra Crni ◽  
Miroslav Markovic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Saphenous Vein ◽  
Varicose Veins ◽  
World Health ◽  
Superficial Thrombophlebitis ◽  
Perforating Veins ◽  
Long Saphenous Vein ◽  
Significant Difference ◽  
Primary Varicose Veins ◽  
Short Saphenous Vein

INTRODUCTION According to the definition of the World Health Organization, varicose veins represent abnormally enlarged superficial veins having baggy or cylindrical shape. The most frequent cause of primary varicose veins is the insufficiency of long saphenous vein (LSV), but especially the basin of its connection with femoral vein and perforating veins. OBJECTIVE The objectives of these investigations were: the determination of insufficiency incidence of SSV in cases of LSV insufficiency; the establishment of association of insufficiency of perforating veins of the basin of LSV and SSV; the study of the results of surgical treatment of insufficiency and varicosity of both short and long saphenous veins. METHODS In this study, 100 patients (66 women and 34 men), average age 52.1 years, with clinical symptoms showing the insufficiency and varicosity of long saphenous vein with no change of deep vein system were examined. Ultrasonographic examinations were made using Color Doppler probes - 7.5 and 3.75 MHz (Toshiba Corevison SSA 350 A); the development of incompetence of long saphenous vein (LSV) and short saphenous vein (SSV) at the level of the junction as well as other incompetent valves were examined. The reflux was defined as a retrograde flow of the duration longer than 0.5 seconds. RESULTS The insufficiency of short saphenous vein was determined by ultrasonographic examination in 34%, while the insufficiency of perforating veins in 80% of patients. 40% of patients were operated (33.3% of females, and 52.9% of males). The most frequent indications for surgical treatment of superficial veins insufficiency were: strong varicosities, clear symptoms and signs, superficial thrombophlebitis and conditions after superficial thrombophlebitis. Surgical treatment was applied in 16% of patients due to recurrence in the basin of long saphenous vein, and in 6% of cases because of the recurrence in the basin of short saphenous vein. Data analysis failed to discover any statistically significant difference between the age of patients and varicosities in the basin of long saphenous vein as well as in the basin of short saphenous vein (51.98?9.97 years; 54.50?31.82 years; t=0.36; p>0.05), or any significant difference of BMI value, with regard to the obesity of patients and varicosities in the basin of long saphenous vein as well as in the basin of short saphenous vein (28.02?4.61 kg/m2; 24.50?6.36 kg/m2; t=0.50; p>0.05). No statistically significant correlation was found between Color Duplex findings of insufficiency of both long saphenous vein and short saphenous vein (p=-0.21 ; p>0.05), nor any significant correlation of Color Duplex findings of perforating veins insufficiency in the basin of long saphenous vein and short saphenous vein (p=-0.115; p>0.05). CONCLUSION The incidence of insufficiency is significant: approximately every third patient has short saphenous vein insufficiency, while three third of patients have perforating veins insufficiency. Color Duplex limb's veins ultrasonography is highly reliable method for the examination and study of superficial veins diseases, which is very important for preoperative decision-making and selection of surgical technique as well as for postoperative follow-up.

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