A Study of Tourniquets in the Investigation of Venous Insufficiency

1991 ◽  
Vol 6 (2) ◽  
pp. 133-139 ◽  
Author(s):  
G.M. McMullin ◽  
P.D. Coleridge Smith ◽  
J.H. Scurr
Keyword(s):  
Doppler Ultrasound ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Venous Pressure ◽  
Venous Disease ◽  
Retrograde Flow ◽  
Pneumatic Tourniquet ◽  
Long Saphenous Vein ◽  
Duplex Doppler ◽  
Source Of Error

Tourniquets are used extensively in the assessment of the venous system. They are employed not only for clinical tourniquet tests but are also used during examinations by Doppler ultrasound, plethysmography and venography, and during ambulatory venous pressure measurements. Surgical management is based on conclusions reached by the use of tourniquets. This study was undertaken to evaluate the pressure required to prevent reflux in the incompetent long saphenous vein. A total of 44 limbs with sapheno–femoral incompetence were studied. Duplex doppler ultrasound was used to detect retrograde flow within the long saphenous vein during inflation of a 2.5 cm wide pneumatic tourniquet applied around the thigh. The pressure required to prevent reflux, the diameter of the imaged vein and the circumference of the thigh were measured. The pressure required to prevent reflux varied from 40 mmHg to 300 mmHg. There was a correlation between this pressure and the circumference of the thigh ( r = 0.62 P < 0.001). There was no correlation with the diameter of the vein. In conclusion, tourniquets introduce a source of error into evaluation of venous disease.

Varikose der V. saphena accessoria lateralis: Darstellung des Rezirkulationskreislaufs durch präoperative Phlebographie

VASA ◽  
2001 ◽  
Vol 30 (1) ◽  
pp. 28-36 ◽  
Author(s):  
Jürgen Weber ◽  
J. Lambrecht
Keyword(s):  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Venous Pressure ◽  
Lower Leg ◽  
Side Branch ◽  
Pressure Measurements ◽  
Functional Disorders ◽  
Long Saphenous Vein ◽  
Anterior Side

Background: The incidence of varicosis of the anterior side branch of the long saphenous vein clinically ranges about 8 to 10% of descending venous decompensation, originating at the level of the thigh. Its incidence in women showing significant overweight is clearly pronounced. Mostly torturous and enlarged varicosed segments of the accessorial lateral saphenous vein can be seen clinically crossing the anterior middle of the thigh. The indications for surgical radical extirpation of the entire varicosed side branch depends from pain, phlebitic complications, peripheral venous dysfunction including cosmetic aspects. Patients: In a clientel of 138 patients (females: 114, males: 24) the phlebographic demonstration of the entire recirculation pathways was performed prior to surgery. Results: Ascending leg phlebography was found sufficient in 7.7% of cases only. Combined with varicography however, in further 90,7% of patients a clear demonstration of the upper and lower points of venous insufficiency was possible. The extent of functional disorders was calculated by additional peripheral venous pressure measurements. Conclusions: This clientel clearly shows that long-term reflux via the varicosed side branch increases the tendency of peripheral functional decompensation along the lower leg. Adequate surgical therapy depends from a clear demonstration of the varicosed veins beeing involved, and this can be realized by combined phlebography and varicography.

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.

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

Morphological Study of the Valvular Distribution in the Long Saphenous Vein

1994 ◽  
Vol 9 (2) ◽  
pp. 59-62 ◽  
Author(s):  
F. Ortega ◽  
L. Sarmiento ◽  
B. Mompeo ◽  
A. Centol ◽  
A. Nicolaides ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Saphenous Vein ◽  
Lower Limb ◽  
Morphological Study ◽  
Venous Disease ◽  
Gran Canaria ◽  
Anatomical Dissection ◽  
Long Saphenous Vein ◽  
Below The Knee ◽  
Academic Vascular Surgery

Objective: To measure the distribution of valves in the long saphenous vein. Design: Morphological study of the intervalvular distance of the long saphenous vein. Setting: Department of Morfología, Facultad de Ciencias de la Salud (Universidad de Las Palmas de Gran Canaria, Spain) and Academic Vascular Surgery Unit, St Mary's Hospital, London, UK. Material: Twenty lower extremities from adult cadavers with no evidence of lower limb venous disease. Methods: Anatomical dissection of the long saphenous vein, with accurate measurement of valve distribution. Results: There were on average 8.7 valves in the long saphenous vein, with 6.3 above the knee and 2.4 below the knee. Conclusion: Contrary to classical anatomical texts on this subject there are more valves in the long saphenous vein in the thigh than in the calf.

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.

Selective Saphenous Vein Repair: A 5-Year Follow-up Study

1992 ◽  
Vol 7 (3) ◽  
pp. 121-124 ◽  
Author(s):  
G. Belcaro ◽  
B. M. Errichi
Keyword(s):  
Saphenous Vein ◽  
Venous Pressure ◽  
Randomized Study ◽  
Control Group ◽  
General Anaesthetic ◽  
Inclusion Criteria ◽  
Follow Up Study ◽  
Long Saphenous Vein ◽  
Saphenofemoral Junction

objective: To evaluate the effect of selective saphenous vein repair (SSVR) in a 5-year follow-up study. Design: Prospective, randomized study of 44 subjects randomized to an SSVR group and a control group. Setting: University Clinic, Chieti, and Angiology and vascular Surgery Clinic, Pescara, Italy. Patients: Twenty-two patients in the SSVR group and 22 in the control group. Inclusion criteria were incompetence of the saphenofemoral junction (SFJ) with presence of valve cusps and two to five venous sites in the long saphenous vein. interventions: SFJ plication and selective interruption of the incompetent sites under general anaesthetic. Main outcome measures: Ambulatory venous pressure measurements (refilling time) and colour duplex scanning to detect the number of incompetent sites. Result: After 5 years, 18 patients in the SSVR group and 19 in the control group completed the study. SSVR increased refilling time ( p<0.02) and the number of incompetent sites was decreased ( p<0.02); in the control group, refilling time remained short and the number of incompetent sites increased ( p<0.05). Conclusion: SSVR is an effective treatment with good 5-year results on incompetence and the development of new incompetent venous sites.

A Reassessment of the Role of Perforating Veins in Chronic Venous Insufficiency

1990 ◽  
Vol 5 (2) ◽  
pp. 85-94 ◽  
Author(s):  
G.M. McMullin ◽  
H.J. Scott ◽  
P.D. Coleridge Smith ◽  
J.H. Scurr
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Reverse Flow ◽  
Venous Pressure ◽  
Signs And Symptoms ◽  
Venous Hypertension ◽  
Venous Disease ◽  
Perforating Veins ◽  
Clinically Normal

Ambulatory venous hypertension is closely associated with the signs and symptoms of venous disease. It has been shown that reverse flow of blood in the superficial and deep veins is responsible. The pressure derangement caused by incompetence of perforating veins has not been established. The present study documents the pressure disturbances caused by incompetence in each of the three compartments of the venous system, the deep, the superficial and the perforating veins. In total 90 limbs of 49 patients with chronic venous insufficiency were examined and classified by duplex scanning and ascending venography. Ambulatory venous pressure measurements were performed on all 90 limbs and a venous sufficiency index (VSI) for each limb calculated from the percentage drop in pressure and refilling time. VSI was lowest in the group with deep vein incompetence (median 0.9, range 0–36.9), intermediate in the groups with superficial vein incompetence (median 7.6, range 0.4–59) and with incompetent perforating veins (median 14.6, range 0.4–35.7) and highest in the group with normal veins (median 41.7, range 3.5–87.5). The association of symptoms and VSI was also examined. The lower the VSI the more severe were the clinical symptoms and all ulcerated limbs had a VSI < 20. However a number of clinically normal limbs were also found to have low values of VSI.

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