In order to salvage the extremity of dog with marked ischemia from extensive damage of the artery, an operation, diversion of saphenous artery and vein with the anterior tibial artery and vein was tried. The results showed that this operative technique was feasible as a method of treatment. Basing on this fact, the diversion of the saphenous vein in situ with the femoral artery, combined with selective extirpation of the valve of thd vein was used to treat 14 cases (15 limb) of high obliteration of artery of the lower extremities with good results.
【Abstract】Objective To evaluate the clinical value of photoplethysmography (PPG) in the diagnosis of venous valvular incompetence of lower extremity. Methods Two hundreds and six lower limbs in 181 patients including primary deep venous incompetence(PDVI), simple superficial veins incompetence and simple cross veins incompetence were examined by PPG in the assessment of venous refill time(VRT). All limbs underwent deep vein venography. Results Using venography as control the sensitivity of PPG was 89.8% and the specificity was 83.3 % in the diagnosis of venous valvular incompetence of lower extremity. Conclusion PPG could be taken as clinical diagnostic method for venous valvular incompetence of the lower extremity. The feature of PPG is noninvasive, painless with nonallergic reaction. The authors suggest that PPG can be used as a screening procedure for performing venography and postoperative follow-up.
Objective To compare canine decel luarized venous valve stent combining endothel ial progenitor cells (EPC) with native venous valve in terms of venous valve closure mechanism in normal physiological conditions. Methods Thirty-six male hybrid dogs weighing 15-18 kg were used. The left femoral vein with valve from 12 dogs was harvested to prepare decelluarized valved venous stent combined with EPC. The rest 24 dogs were randomly divided into the experimental group and the control group (n=12 per group). In the experimental group, EPC obtained from the bone marrowthrough in vitro ampl ification were cultured, the cells at passage 3 (5 × 106 cells/mL) were seeded on the stent, and the general and HE staining observations were performed before and after the seeding of the cells. In the experimental group, allogenic decelluarized valved venous stent combined with EPC was transplanted to the left femoral vein region, while in the control group, the autogenous vein venous valve was implanted in situ. Color Doppler Ultrasound exam was performed 4 weeks after transplantation to compare the direction and velocity of blood flow in the distal and proximal end of the valve, and the changes of vein diameter in the valve sinus before and after the closure of venous valve when the dogs changed from supine position to reverse trendelenburg position. Results General and HE staining observations before and after cell seeding: the decelluarized valved venous stent maintained its fiber and collagen structure, and the EPC were planted on the decelluarized stent successfully through bioreactor. During the period from the reverse trendelenburg position to the starting point for the closure of the valve, the reverse flow of blood occurred in the experimental group with the velocity of (1.4 ± 0.3) cm/s; while in the control group, there was no reverse flow of blood, but the peak flow rate was decreased from (21.3 ± 2.1) cm/s to (18.2 ± 3.3) cm/s. In the control group, the active period of valve, the starting point for the closure of the valve, and the time between the beginning of closure and the complete closure was (918 ± 46), (712 ± 48), and (154 ± 29) ms, respectively; while in the experimental group, it was (989 ± 53), (785 ± 43), and (223 ± 29) ms, respectively. There was significant difference between two groups (P lt; 0.05).After the complete closure of valve, no reverse flow of blood occurred in two groups. The vein diameter in the valve sinus of the experimental and the control group after the valve closure was increased by 116.8% ± 2.0% and 118.5% ± 2.2%, respectively, when compared with the value before valve closure (P gt; 0.05). Conclusion Canine decelluarized venous valve stent combined with EPC is remarkably different from natural venous valve in terms of the valve closure mechanism in physiological condition. The former rel ies on the reverse flow of blood and the latter is related to the decreased velocity of blood flow and the increased pressure of vein in the venous sinus segment.
下肢慢性静脉功能不全（chronic venous insufficiency, CVI）是国人常见的血管外科疾病。人们最早认识的是以大隐静脉曲张为代表的浅静脉功能不全。20世纪初Homans就提出治疗大隐静脉曲张的手术方式“大隐静脉高位结扎、抽剥术”，至今仍为治疗该病的经典手术方式。尽管100年来对此手术方式有所改良或改进，但手术的基本原则并未改变，即消除曲张浅静脉（不管用什么方式）以打断浅静脉返流，达到降低静脉高压的目的。......
目的 评价股浅静脉瓣膜环形缩窄术治疗原发性下肢深静脉瓣膜功能不全(primary deep venous insufficiency,PDVI)的疗效和应用价值。方法 2002年4月至2006年4月期间经顺行性静脉造影加Valsalva试验证实为PDVI者119例(158条),其中2002年4月至2004年1月收治者仅行大隐静脉高位结扎剥脱+交通支结扎术(前期治疗组),2004年2月至2006年4月收治者在前期治疗方法的基础上加行股浅静脉瓣膜环形缩窄术(后期治疗组),以CEAP(clinical,etiologic,anatomic,and pathophysiologic)临床分级与临床记分评价2组的疗效。结果 2组患者术后临床分级及临床记分均明显下降(前期治疗组由5.9±3.6降至2.1±1.3,P＜0.01; 后期治疗组由6.4±3.5降至1.7±1.8,P＜0.01),且后期治疗组较前期治疗组下降程度更大(P＜0.01)。结论 股浅静脉瓣膜环形缩窄术有助于PDVI患者临床症状缓解,因此术前明确诊断为PDVI的患者,应行股浅静脉瓣膜环形缩窄手术。
ObjectiveTo analyze the causes of lower extremity varicose veins and assess the value of deep vein imaging in diagnosing and treating venous diseases, according to deep vein angiography examination results under digital subtraction angiography. MethodsDuring January 2012 to January 2013, 689 cases of lower limb varicose veins in 394 patients underwent lower extremity deep venous anterograde contrast examination, among which 87 patients also underwent left femoral venous trocar puncture angiography examination and 46 patients underwent femoral vein puncture inferior vena cava angiography examination at the same time. Then the results of imaging data were analyzed. ResultsThe causes of lower limb varicosity, according to its incidence, were as follows:primary deep venous valve incompetence (349 limbs of 184 patients) accounting for 50.7%, simple varicose veins of lower limbs (148 limbs of 95 patients) accounting for 21.5%, left iliac vein compression syndrome (121 limbs of 69 patients) accounting for 17.6%, cloth plus syndrome (54 limbs of 34 patients) accounting for 7.8%, post-thrombotic syndrome (16 limbs of 11 patients) accounting for 2.3%, and Klipple-Trenaunay syndrome (1 patient) accounting for 0.1%. ConclusionVaricose vein of lower limb is a common clinical manifestation of a variety of diseases, and the primary deep venous valve incompetence is the leading cause. Varicose veins of lower limb deep vein angiography is a reliable method for examination of lower extremity venous disease, and a basis for the choice of other treatments as well.
In order to evaluate the effect and indication of three kinds of deep-venous valve reconstruction surgery, 62 cases with venous reflux disease of the leg had been treated from Jan. 1992 to Jun. 1996. All the patients had varicose vein and tingle in varying degrees, besides swelling in 30 cases, pigmentation in 28 cases, ulcer in 14 cases. The course of disease ranged from 1 to 30 years (averaged 14.6 years). METHOD: 14 cases were treated by ringing of the superficial femoral venous 1st valve, 1 case was treated by repairing of the superficial femoral venous 1st valve, 47 cases were treated by formation of substitute valve outside the popliteal vein. The symptoms of all the patients were alleviated with an average follow-up for 20 months. Fourteen cases with ulcer were healed compeletely and no recurrence. The conclusion were: 1. ringing and repairing of the venous valve were suitable for level I-II venous valvular incompetence. 2. formation of substitute valve outside the popliteal vein was suitable for level III-IV venous valvular incompetence or congenital valvular defect. 3. the width of the ringing material should be increased to 2 cm according to the pathological basis. 4. both femoral veins should be ringed in the treatment of primary valvular incompetence of double deep vein deformity. 5. the formation of substitute valve outside the popliteal vein was also available in the treatment of popliteal vein with many branches.
Objective To investigate the value of color Doppler ultrasonography in the examination of perforating veins of the lower extremities by comparing with X-ray antegrade venography. Methods Fifty-three patients (60 lower extremities) clinically diagnosed with varicosis of the great saphenous vein from January 2014 to March 2016 were selected for color Doppler ultrasonography and X-ray antegrade venography. The results were compared and confirmed by surgery. Results Forty-seven lower extremities were diagnosed with perforating venous valve insufficiency by color Doppler ultrasonography, while 50 lower extremities by X-ray antegrade venography. There was no significant difference between the two methods (χ2=0.800, P=0.371). A total of 78 perforating veins were detected by color Doppler ultrasonography, with 1–4 perforating veins per one lower extremity. Among them, 66 perforating veins had an internal diameter of 2–5 mm, accounting for 84.6%. Except two perforating veins with an internal diameter <2 mm, the rest showed reflux. In addition, a total of 73 perforating veins presented distance to the pelma of 10–32 mm (foot-boot), accounting for 93.6%. Fifty-two lower extremities with varicosis of the great saphenous vein underwent laser ablation of the great saphenous vein with high ligation or + devascularization of perforating veins. Compared with operation findings, color Doppler ultrasonography in diagnosis of perforating venous valve insufficiency had 37 true positives, 2 false positives, 10 true negatives and 3 false negatives, and the sensitivity was 92.5% (37/40), the specificity was 83.3% (10/12), the accuracy rate was 90.4% (47/52). Conclusions Color Doppler ultrasonography can accurately localize perforating veins, measure the internal diameter and observe the degree of reflux. It is of high sensitivity and accuracy in the diagnosis of perforating venous valve insufficiency. Moreover, it is safe, simple and economical, and suitable for preoperative and intraoperative diagnosis and localization.
ObjectiveTo compare vein valve function following pharmacomechanical thrombolysis (PMT) with simple catheter-directed thrombolysis (CDT) for deep vein thrombosis.MethodsWe retrospectively analyzed the clinical data of sixty patients who suffered acute lower extremity deep vein thrombsis in our hospital between October 2016 and March 2017. All patients underwent contralateral preprocedural duplex and bilateral postprocedure duplex to access patency and valve function. The patients were divided into three groups including a group A with catheter-directed thrombolysis (CDT) alone (36 patients with 20 males and 16 females at average age of 56 years), a group B with PMT alone (15 patients with 8 males and 7 females at average age of 55 years), and a group C with PMT combined CDT (9 patients with 4 males and 5 females at average age of 56 years). The valve function was compared among the Group A, Group B and Group C.ResultsThere were 40.0% (24/60) patients with bilateral femoral vein valve reflux, 40.0% (24/60) patients with unilateral femoral vein valve reflux (all in the treated limbs), 20% (12/60) patients had no reflux in both limbs. Of the limbs treated with CDT alone, PMT alone and PMT combined CDT, the rate of valve reflux was 38.9% (14/36), 33.3% (5/15), and 55.6% (5/9) respectively (P=0.077).ConclusionIn the patients suffering acute DVT, PMT or PMT combined CDT does not hamper valve function compared with CDT alone.
Objective To study the effectiveness of substitute valve at the popliteal vein in treatment of deep venous valve insufficiency of lower extremities. Methods From January 1996 to August 2002, 27 patients were diagnosed having deep venous valve insufficiency of lower extremities by color Doppler and radiography with an average disease course of 17.4 years.All 27 patients had varicose vein, 25 pain, 22 swelling,25 pigmentation in ankle area and 19 chronic ulcerations.Two cases had been treated with great saphenous vein ligation and striping.Averagevein pressure in resting position was (11.00±0.73)kPa,and the ambulatory venous pressure was (9.14±0.68)kPa.All patients were treated with substitute valve at the popliteal vein,and great saphenous vein ligation and stripping, some were treated with subfascial endoscopic perforating veins ablation. Results The average ambulatory venous pressure after operation was (5.94±0.82)kPa,were significantly different from that before operation(P＜0.01). The curative results were satisfactory,and all symptom and physical sign disappeared.After a mean follow-up period of2-6 years,21 cases had satifactory results. Conclusion Substitute valve at the popliteal vein have the value of widespread application.