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PubMed1997

[Chronic venous pathology: presentation of a new international classification].

The Authors present a new classification of chronic venous pathology. The first presentation was in Maui during the Congress of the North American Society of Phlebology and the second in London, during the last World Congress of International Union of Phlebology. The aim is to standardize the clinical and instrumental data to propose a common classification to all physicians. Etiological, anatomical, physiopathological and clinical findings were considered.

Chronic Disease↗
PubMedDate not supplied

[Crenotherapy of postphlebitic disease at Bagnoles-de-l'Orne studied by occlusive rheoplethysmography].

We have attempted to demonstrate by occlusive rheoplethysmography the action of crenotherapy on post-phlebitic syndrome. At the end of the study, it appears that, if it is possible to calculate the tissue disinfiltration obtained at the end of the cure, the method should be completed by diversified and repeated examinations after the cure in order to specify the beneficial effect of the cure.

Adult↗
PubMed1986

[Long-term normovolemic hemodilution in refractory postphlebitic ulcers].

Thrombo-embolic complications are still amongst the most serious encountered in surgery and in certain medical afflictions, despite the different forms of prophylaxis, and in particular subcutaneous heparin. Thus, in 1983, an investigation by Salleras in Barcelona based on 37,400 cases, assessed the incidence of these complications after surgery at a rate of 2.5%. That is why post-phlebitic syndromes, the results of late diagnosis at the acute stage and/or inappropriate treatment, are disorders which are still very widespread, chronic, and more or less incapacitating. At the root of tissue modifications and trophic disorders which are seen in the post-phlebitic illness, a state of venous stasis at the periphery of the limbs is very often encountered; it depends on the following processes: the obstruction of a large venous collector (obstructive syndrome), the size of the stasis depending on the functional value of the anastomotic channels; the insufficiency of the superficial network; orthostatic reflux in the repermeabilized deep veins whose valvular system has broken down. The main trophic complications are: oedema, hypodermatitis and leg ulceration, which is the most formidable complication and which still occurs very frequently. Most post-phlebitic ulcers heal after a well-executed phlebological treatment on an ambulatory basis. A certain number of these ulcers prove, however, to respond badly to ambulatory treatment; they are called resistant post-phlebitic ulcers. By definition, they are difficult to cure; however, it has recently been apparent that the classical treatments associated with long-term isovolaemic haemodilution are more effective and enable healing to take place by treating the venous stasis and the increased blood viscosity.

Adult↗
PubMed1981

Hyperstomy Syndrome-a new approach for the treatment of lymphedema of the lower legs.

To improve the results after surgical treatment of the lower legs' lymphedema, a new approach was developed by surgical ligation of the abnormal arteriolovenular shuntings. (Hyperstomy Syndrome). These findings are very common in congenital and postphlebitic lymphedemas. The abnormal branchings are easily localized by serial arteriography. The excision techniques like the Charles' operation, presents after this new method much better esthetic appearance with out formation of hyperkeratosis of verrucous warts commonly found after these operations.

Angiography↗
PubMed1984

The substitute "valve" operation by technique II in patients with postthrombotic syndrome.

The substitute "valve" operation with use of a silicone tendon designed to produce a valvelike mechanism in the popliteal veins of 29 patients with 31 postphlebitic limbs caused by reflux in the deep veins is described. The results have been assessed by measurements, taken during ambulation, of venous pressure before operation, 1 week after operation, and 1 year after operation and by phlebography. In 29 limbs there was clinical improvement associated with improvement in the venous pressure assessed during ambulation and phlebographic evidence of a functioning substitute valve.

Hemodynamics↗
PubMed1994

[Color Doppler and phlebography in the Paget-Schroetter syndrome].

The authors compared the adequacy of phlebography and color-Doppler US in the diagnosis of subclavian-axillary thrombosis, or Paget-Schroetter syndrome. Ten patients with subclavian-axillary thrombosis (8 men and 2 women, aged 16 to 55 years, mean age: 30 years) were examined over a two-year period. All of them underwent color-Doppler US and conventional phlebography in the same session. US findings were in agreement with phlebographic results in all cases as to thrombosis presence and site. The thrombosis involved the subclavian-axillary vein in 8 cases, the subclavian-innominate vein in 1 case and both veins in 1 case. Color-Doppler US, however, yielded no information relative to the superior vena cava; these data were always obtained with phlebography even though in 4 cases that segment had to be studied with phlebographic opacification via contralateral route. Furthermore, US failed to clearly demonstrate the thrombosis involving the last axillary valve; preserving this valve is indeed the main aim of fibrinolysis since its integrity, at this level, prevents venous reflux independent of subclavian-axillary trunk recanalization, thus reducing the severe symptomatologic sequelae following postphlebitic damage. Phlebography showed the valve and its possible involvement in all cases. In 4 cases phlebography also demonstrated compressive thoracic inlet syndrome, which had been missed by US, yielding the main anatomic elements for following surgery. To conclude, the authors suggest noninvasive color-Doppler US as the screening method of choice, while phlebography remains the gold-standard technique to be performed in all Doppler positive cases: in fact, the latter method yields more pieces of information and is more panoramic than the former, besides allowing fibrinolysis effects to be studied and the possible presence of an associated thoracic inlet syndrome to be investigated.

Adolescent↗
PubMedDate not supplied

[Surgery in postphlebitic disease. Apropos of 157 surgical interventions].

Surgery occupies only a restricted position in post-phlebitic illness. The authors analyse 157 surgical operations carried out on 138 patients between 1969 and 1983. A detailed report is always given pre-operatively as a matter of course by Functional examination and phlebography, in order to locate the predominant physiopathological disorder or disorders: superficial venous deficiency--reflux via the perforators--the obliteration syndrome or devalvulation syndrome of the deep venous system. After a short listing of the surgical methods, the results of these different operations are analysed. They are hard to assess. Where there is a relapsing ulcer, surgery of the perforators produces 70 percent good results. The therapeutic indications are discussed, finally, on the basis of recently published series and the authors' experience.

Femoral Vein↗
PubMed1986

Non-iatrogenic deep vein thrombosis of lower extremities in children.

Non-iatrogenic ileo-femoral vein thrombosis is rarely encountered in childhood. Six children with postphlebitic leg following venous thrombosis are presented. Venous thrombosis occurred following peritonitis, osteomyelitis and scarlet fever. None of the patients had history of trauma or intravenous treatment. Based on world literature and our experience, the main clinical and radiological manifestations of this rare entity are summarised. Early detection and aggressive anti-coagulant therapy of deep vein thrombosis may probably prevent post-thrombotic syndrome--a major disabling condition in children.

Adolescent↗
PubMedDate not supplied

[Classical surgical experience in postphlebitic disease].

Besides the current methods of shunting and the restoration of the valve system, the surgery of venous deficiency remains important in other ways too. The superficial venous system plays a supply rôle at the stage of acute thrombosis but, once it has become dilated, it becomes deficient and so becomes the location for orthostatic reflux; in post-phlebitic illness, this superficial deficiency is often further complicated by a deficiency of the tibial communicating veins, the pathogenic implication of which is significant. Correction of these haemodynamic disorders by classic methods may be effected either in isolation or in association with an operation aimed at the obstructive syndrome or the syndrome of deep reflux; particular attention must be paid to the problem of the tibial communicating veins. Surgical indications are definitively based on a precise physiopathological report on the post-phlebitic syndrome causing the problem.

Humans↗
PubMed1986

Spontaneous deep vein thrombosis in childhood and adolescence.

Deep vein thrombophlebitis (DVT), unrelated to intravenous catheters, is unusual in children. During the period between 1970 to 1984, 15 cases of spontaneous DVT were seen at The Montreal Children's Hospital. The female to male ratio was 2:1. Age ranged from 10 to 17 years. Venogram was positive in the 14 patients in whom it was done. Significant factors were related to the DVT in 12 patients: oral contraceptives, pelvic fracture, Ewing's sarcoma and chemotherapy, brain tumor, nephrotic syndrome, and ulcerative colitis (2, one of whom developed the DVT 3 months before the onset of gastrointestinal symptoms). The sites of thrombophlebitis encountered were left iliofemoral vein, right iliofemoral, right tibial, and left subclavian. Three patients developed pulmonary emboli, which were recurrent in two and required iliac vein ligation or inferior vena cava clipping. Treatment usually consisted of intravenous heparin followed by oral anticoagulants for 3 to 6 months. Two patients received streptokinase with good results. All the patients recovered. With a limited follow-up (6 months to 5 years), we have not seen any postphlebitic sequelae.

Adolescent↗