scholarly journals Sonography and multislice contrast tomography in the diagnosis of chronic venous insufficiency complicated by trophic ulcers

2021 ◽  
Vol 11 (7) ◽  
pp. 316-323
Author(s):  
O. Kolomiets
Keyword(s):  
Computed Tomography ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Multislice Computed Tomography ◽  
Venous Blood ◽  
Lower Extremities ◽  
Venous System ◽  
Venous Blood Flow ◽  
Planning Stage ◽  
X Ray

Sonography has become the gold standard in the diagnosis of pathological changes in venous insufficiency, however, studies by other scientists indicate the need for a comprehensive study using phlebographic methods. The aim of the work was to compare the results of sonography and multislice tomography in the diagnosis of chronic venous insufficiency complicated by trophic ulcers. Materials and methods. The results of treatment of 97 patients with chronic venous insufficiency in stage C6 and C6r were evaluated. Ultrasound angioscanning of the venous system of the lower extremities at the planning stage of surgical treatment and in the postoperative period (early and after a year of observation) was performed on a digital device of expert class for cardiovascular studies (Toshiba Aplio 500) with 5-10 MHz sensor and appropriate standard software package examination of the venous system of the lower extremities. Multislice computed tomography was performed using X-ray computed tomography (Philips Brilliance 64). The study was performed using X-ray contrast iodine-containing medium (Omnipack-350) at the rate of 1 ml of the drug per kilogram of patient weight. Research results and their discussion. the sonographic study found that the causes of trophic ulcers were impaired venous blood flow in the veins of the lower extremities due to severe varicose transformation and decompensated reflux, and changes in the deep venous system due to thrombosis of the deep veins. Greater sensitivity and specificity of multislice computed tomography in the diagnosis of postthrombotic stenoses and obliterations were found compared with sonographic examination. This method is valuable in the study of the anatomy of the venous system, but does not allow to assess the parameters of hemodynamics (duration and degree of reflux, but only its presence).

scholarly journals Review of the plethysmographic methods for studying hemodynamic disorders in patients with chronic lower extremites venous diseases

2020 ◽  
pp. 58-70
Author(s):  
A. B. Sannikov ◽  
V. M. Emelyanenko ◽  
I. V. Drozdova
Keyword(s):  
Blood Flow ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Venous Blood ◽  
Lower Extremities ◽  
Venous Blood Flow ◽  
Residual Volume ◽  
Venous Outflow ◽  
Non Invasive ◽  
Venous Diseases

Plethysmography as a method for studying peripheral circulatory system was first proposed by wletney in 1953. In Russia, the first most significant research studies on the feasibility of plethysmography in studying peripheral blood flow and circulatory physiology taken together were conducted at the St. Petersburg Pavlov Institute of Physiology in 1961. From this time onwards, the possibilities of plethysmography as a non-invasive objective method for the diagnosis of hemodynamic disorders, particularly in arterial pathology, were studied intensively. These parameters were not determined for the venous blood flow, but in 1980s the authors were able to establish plethysmographic criteria not only for various forms of venous pathology, but also for degrees of chronic venous insufficiency using a device significantly improved by V.N. Pavlov and V.E. Maslov.The purpose of this publication is to analyze the literature data on the use of aerial plethysmography and photoplethysmography in the study of hemodynamic disorders in patients with chronic diseases of the veins of the lower extremities. At present, in order to assess the venous blood flow in condition of air plethysmography, indicators of functional venous volume (VV), maximum venous outflow (MVO), venous filling index (VFI), evacuation volume (EV) and residual volume (RV), as well as an integral indicator – residual volume fraction (RVF) are determined in the world. A venous reflux test (VRT) is performed as part of photoplethysmography. The data published today show the high statistical reliability of the comparative analysis and the great scientific significance of the research. According to many foreign authors the use of plethysmographic methods of diagnosis allow to assess violations of venous blood flow in patients with chronic venous diseases of various clinical classes according to CEAP more precisely and to give a global assessment of disorders of the venous outflow from thrombotic occlusion of segmental to hypervolemia in patients with varicose veins in different forms of manifestations of chronic venous insufficiency. The analysis of the literature data allows to make a conclusion about the prospects of further research using these non-invasive methods of evaluation of venous blood flow in the lower extremities.

Limited Blood Fluidity as a Contributory Factor of Venous Stasis in Chronic Venous Insufficiency

1989 ◽  
Vol 4 (2) ◽  
pp. 107-111 ◽  
Author(s):  
E. Ernst ◽  
A. Matrai ◽  
M. Marshall
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Venous Blood ◽  
Cell Aggregation ◽  
Plasma Viscosity ◽  
Venous Stasis ◽  
Contributory Factor ◽  
Venous Blood Flow ◽  
Red Cell ◽  
Red Cell Aggregation

Patients with chronic venous insufficiency were compared to matched controls in terms of blood and plasma viscosity, haematocrit, blood cell filterability, red cell aggregation, fibrinogen and ESR. The results show that in chronic venous insufficiency plasma viscosity and red cell aggregation are elevated, while blood cell filterability is reduced. Furthermore, the venous blood flow velocity (as determined by Doppler technique) correlates inversely with both plasma viscosity and red cell aggregation. We conclude that the systematic rheological abnormality increases the resistance to venous blood flow and may represent a contributory factor of venous stasis in this disorder.

scholarly journals SURGICAL TREATMENT OF COMPLICATED FORMS OF CHRONIC VENOUS INSUFFICIENCY IN LOWER LIMBS (REVIEW ARTICLE)

2020 ◽  
Vol 20 (4) ◽  
pp. 209-215
Author(s):  
V. І. Liakhovskyi ◽  
R. M. Riabushko ◽  
А. V. Sydorenko
Keyword(s):  
Surgical Treatment ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Lower Extremities ◽  
Integrated Treatment ◽  
Lower Limbs ◽  
Venous Blood Flow ◽  
Venous Reflux ◽  
Surgical Interventions ◽  
Cosmetic Effect

Venous diseases of the lower limbs that are accompanied by the development of trophic ulcers are among the medical and social challenges. The vast number of patients is in working age, from 30 to 65 years old. Severe forms of the disease are registered in 27% of the cases; active or healed trophic ulcers are diagnosed in 12.9 % of cases. At present special attention is being paid to the effective surgical treatment of the pathology, to the introduction of the latest surgical interventions, which provide complete radicalism about the causes of trophic ulcers of venous genesis and ensure the maximum cosmetic effect. The aim of this work is to analyze the scientific literature on using the latest surgical techniques in the treatment of venous pathology in patients with trophic ulcers of lower extremities to promote improving the existing and elaborate new surgical interventions in terms of this pathology. Nowadays surgical treatment of patients with chronic venous insufficiency of the lower extremities, especially in case of trophic leg ulcers can be considered as the stage of the integrated treatment of venous trophic disorders. Modern surgical interventions differ in the methods, techniques and tools used, but provide the maximum cosmetic effect and complete radicalism regarding the causes of chronic venous insufficiency. Correction of pathological venous-venous reflux is the main method of eliminating venous hypertension, which underlies the progression of chronic venous insufficiency and promotes the development of trophic disorders, including the ulcers formation. The etiological cause of venous trophic ulcer is the appearance of pathological reflux, which occurs in the superficial, deep and perforating veins and, accordingly, the place of surgery should be those venous segments in which the pathological process is diagnosed. The operation can be performed simultaneously or in two stages: first, the vertical venous-venous reflux is eliminated, followed by the correction of the horizontal reflux. When using modern minimally invasive technologies, adequate and complete correction of venous blood flow in the affected limb is performed simultaneously producing no serious tissue damages to avoid cosmetic effect and to lessen postoperative period. Thus, the analysis of the scientific literatures has shown the unity of views on the strategy of surgical treatment of varicose trophic ulcers that involves the elimination of vertical and horizontal reflux, but the absence of views unity on tactical approaches in solving these issues.

scholarly journals Photoplethysmographic characteristics of the efficiency of the calf muscle-venous pump in norm and in patients with cvd of various clinical classes according to CEAP

2021 ◽  
Vol 18 (1) ◽  
pp. 103-119
Author(s):  
E. V. Shaydakov ◽  
A. B. Sannikov
Keyword(s):  
Comparative Analysis ◽  
Statistical Significance ◽  
Venous Blood ◽  
Lower Extremities ◽  
T Test ◽  
Calf Muscle ◽  
Venous Blood Flow ◽  
Significance Level ◽  
Venous Diseases ◽  
Detailed Statistical Analysis

Introduction. A literature review on the use of plethysmographic methods for studying the features of venous blood flow in lower extremities under physiological conditions and for global assessment of venous hemodynamics in chronic venous diseases urges to conduct further studies.The aim of the study was to carrying off a detailed statistical analysis of the value of the refilling time (RT) obtained during a photoplethysmographic study (PPG) to evaluate the degree of effectiveness of the calf muscle-venous pump in normal and in patients of different clinical classes according to CEAR.Materials and methods. For the period from 2002 to 2012, 116 healthy individuals with no symptoms of chronic venous diseases and 530 patients with CVD were examined with the use of PPG, with their distribution in accordance with the CEAR international classification as follows: C0-C1 – 140 people (26.42%), C2-C3 – 218 people (41.13%) and 172 persons (32.45%) had trophic disorders, that is, they belonged to the C4-C6 clinical classes. The analysis of the statistical significance of the obtained mathematical characteristics in groups by conducting a t-test for two independent samples calculated by the program and the student’s criterion Z-statistics, to conduct a correlation analysis.Results and discussion. Statistical comparative analysis of the RT value as a result of the t-test at the significance level p < 0,05 showed statistically significant differences between С0-С1, С2-С3 and С4-С6 groups with test with (or no) compression cuff. A stable correlation of average strength was observed between the groups in all cases. The differences were not statistically significant between the Norm and C0-C1 groups. The testing hypotheses for adequacy using linear regression methods allowed us to conclude that conducting a photoplethysmographic examination of patients with CVD of different clinical classes as part of the venous reflux test can provide objective information about the effectiveness of the calf muscle - venous pump. A comparative analysis in groups using the criteria RT > 20 sec and 10 < RT < 20 sec showed that there was no correlation between many groups.Conclusion. PPG is not a universal tool for diagnosing disorders of venous hemodynamics in the lower extremities. The value of RT > 20 seconds can be used as a criterion for evaluating the effectiveness of the calf muscle-venous pump, since more than 70% of cases occur in norm and in patients with C0-C1 clinical classes.

scholarly journals Diagnostic possibilities of thermal vision study of trophic ulcers

2020 ◽  
Vol 19 (2) ◽  
pp. 38-42
Author(s):  
G. V. Yarovenko
Keyword(s):  
Conservative Treatment ◽  
Chronic Venous Insufficiency ◽  
Infrared Radiation ◽  
Venous Insufficiency ◽  
Soft Tissues ◽  
Scattered Light ◽  
Life Quality ◽  
Lower Extremities ◽  
Imaging Method ◽  
Thermal Imager

Chronic venous insufficiency is often accompanied by trophic changes in soft tissues. The treatment of such patients is long and often, ineffective. Relapse of a trophic ulcer is about 30% and leads to deterioration of life quality and dissatisfaction with conservative and even surgical treatment. Goal. Objectification of changes in the microvasculature and compensatory the possibilities of collateral circulation in the lower extremities with complicated forms of chronic venous insufficiency. Materials and methods. The studies were carried out on the Linsor installation characterizing the biological tissue by the change of scattered light intensity and on the thermal imager making possible to determine the temperature of a point with an accuracy of 0,001 degrees, followed by software image processing. The examination was performed 3-4 times in the dynamics of the treatment process and before the patient discharge, from a standard distance of 1,5 meters. The soft tissues in 23 patients with chronic venous insufficiency of the lower extremities and the presence of open trophic ulcers was studied. There were 21 women, 2 men, the average age was 45,2±3,6 years. The area of the ulcer defect varied from 5,7 cm² to 15,3 cm². Patients with extensive trophic ulcers (circular) were excluded from the examination, because of absence of ulcer defect epithelization during the period of hospitalization and its visualization by the thermographic method. Results. As a result of the study, we obtained a reduced intensity of infrared radiation of the ulcer surface in all patients. To clearly isolate ulcerative defect from the surrounding tissues, we set the temperature range 35,0–37,5 °C and recalculated the resulting area in cm² (conversion factor 22,73). We studied the microcirculatory changes occurring in the trophic ulcer and surrounding tissues, confirming the need to continue conservative treatment after complete ulcer defect epithelization for at least 7 days, and only after that period the normalized level of infrared radiation was detected and subsequently relapsed trophic ulcers did not occur for a long time. Conclusion. Based on the obtained data, we confirmed the thermal imaging method sensitivity is suitable for assess of microcirculation in the trophic ulcer area; the method provides the possibility to apply it for the dynamics of conservative treatment in patients with complicated forms of chronic venous insufficiency.

scholarly journals The Influence of Compressive Stockings on the Haemodynamics in the Lower Extremities

1988 ◽  
Vol 3 (3) ◽  
pp. 147-154 ◽  
Author(s):  
A.J.M. Brakkee ◽  
J.P. Kuiper
Keyword(s):  
Healthy Subject ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Venous Pressure ◽  
Lower Extremities ◽  
Limb Volume ◽  
Pump Function ◽  
Muscle Pump ◽  
Elastic Stocking ◽  
Tissue Compression

The influence of an elastic stocking upon the venous muscle pump function in a healthy subject and in a patient with chronic venous insufficiency is discussed. Taking into account the alinear relationship between venous pressure and limb volume the experiences concerning the effects of tissue compression, some of which seem to be contradictory, are clarified.

Acroangiodermatitis

2016 ◽  
Vol 106 (5) ◽  
pp. 364-369
Author(s):  
Anna L. Hronek ◽  
Seth N. Clark ◽  
Gregg Young ◽  
Daniel Kinikini ◽  
Jason Wells
Keyword(s):  
Chronic Venous Insufficiency ◽  
Kaposi's Sarcoma ◽  
Venous Insufficiency ◽  
Lower Extremities ◽  
Kaposi’S Sarcoma ◽  
Histopathologic Examination

Acroangiodermatitis (AAD), also known as pseudo-Kaposi's sarcoma, is an uncommon benign angioproliferative condition most commonly seen in the lower extremities. This condition often presents as discolored patches that progress to painful ulcerations. The list of vascular conditions associated with this diagnosis is vast. Acroangiodermatitis presents similarly to more aggressive conditions such as Kaposi's sarcoma, making histopathologic examination helpful in its diagnosis. We present two cases of AAD in the setting of chronic venous insufficiency.

Inflammation parallels severity of chronic venous insufficiency

2003 ◽  
Vol 18 (2) ◽  
pp. 78-82 ◽  
Author(s):  
N Labropoulos ◽  
D M Leder ◽  
S S Kang ◽  
M A Mansour ◽  
W H Baker
Keyword(s):  
Lymph Nodes ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Normal Subjects ◽  
Flow Patterns ◽  
Flow Reversal ◽  
Venous System ◽  
Arterial System ◽  
Venous Flow ◽  
Phasic Flow

Objective: This study was designed to assess the haemodynamic flow changes in patients with chronic venous insufficiency (CVI). Methods: Duplex scanning was used to evaluate prospectively the flow characteristics in the lower limb circulation and the number of enlarged lymph nodes in the groin of normal subjects, patients with CVI classes 2, 4, 5 and 6, and patients with acute cellulitis. Phasicity and continuous flow patterns were assessed in the venous system, while the arterial system was evaluated for tri-phasic flow, absence of flow reversal and absence of flow reversal with hyperaemic flow (increased peak systolic and end diastolic velocities). Additionally, the number and size of the groin lymph nodes around the saphenofemoral junction were recorded. Results: Patients with more severe class 4-6 CVI demonstrated an increased prevalence of abnormal flow patterns within the venous system of the leg compared to the normal phasic flow pattern seen in the absence of disease ( P < 0.001). Within the arterial system, significant changes were also observed in all three arteries studied in the legs of patients with class 4-6 CVI ( P < 0.001). For both the arterial and venous systems, no difference was noted between control limbs vs class 2 diseases or class 4-6 diseases vs cellulitis. With respect to the evaluation of inguinal lymph nodes, patients with class 2 disease were approximately four times as likely to have positive lymph nodes, and patients with more severe CVI were approximately 13 times as likely to have significant lymph nodes present. Conclusions: This study demonstrated that patients with more advanced stages of CVI had arterial and venous flow increases similar to those seen in an acute inflammatory condition such as cellulitis. These changes were most pronounced in the perforating and subcutaneous vessels in the leg.

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