Venous Hemodynamics in Acute Varicothrombophlebitis of Great Saphenous Vein
Acute varicothrombophlebitis in many countries of the world is the most frequent complication of varicose veins of the lower extremities. Ascending forms of acute varicothrombophlebitis threaten to spread to the deep veins and lead to the pulmonary embolism. The deep vein thrombosis in the background of thrombophlebitis ranges from 10 to 30 % according to the results of color duplex scanning The specificity of the ascending thrombophlebitis of superficial veins is the inability to forecast its course. This is due to the fact that in 30 % of patients the real level of the thrombosis is on 15–20 cm higher than the clinical signs of thrombophlebitis.
The aim of the study. To study the relationship of the venous reflux and local phlebohemodynamics in case of the acute great saphenous vein varicothrombophlebitis.
Materials and Methods. Reflux in the superficial veins of the lower limbs was evaluated based on its spreading in the distal direction according to the diameter changes of the great saphenous vein trunk at the level 1–2 cm proximal to the thrombus top in the lying and standing positions with Valsalva maneuver. Based on the results of the color duplex scanning we divided two groups of patients: I — proximal limit level of the thrombosis in great saphenous vein in lower third of the thigh (47 patients), II — in the upper third of the tibia (36 patients). Each of these groups of patients was divided into two subgroups depending on the prevalence of venous reflux in the great saphenous vein — a local and distributed reflux.
Results and Discussion. Analysis of the own and the literature data shows that errors in case of satisfactory clinical picture, normal condition of sapheno-femoral junction and great saphenous vein diameter in the thigh, but the ascending character of the acute varicothrombophlebitis on tibia may occur in the following complicated variants: 1. Venous reflux from the deep veins via insufficient Dodd’s and Hunter’s perforator veins in the lower third of the thigh goes to the great saphenous vein and reaches the top of the thrombus in upper third of the tibia. 2. In case of insufficient medial sural vein reflux passes to the large saphenous vein through Boyd’s perforator vein. 3. In case of insufficient small saphenous vein reflux moves to the large saphenous vein trunk through collaterals in upper third of the tibia. 4. Segmental thrombophlebitis of the great saphenous vein at the tibia moves through medial posteror perforating group in to the medial gastrocnemius muscle sinus with its thrombosis in the subsequent.
Conclusions. 1. The closer thrombus top to the reflux the greater is its power and the more embolothreating thrombosis is, more frequently we observe the thrombus top floating, more increases the clot formation speed. These cause the surgery urgency in case of sapheno-femoral and sapheno-popliteal junctions and varicose transformed perforator veins thrombosis localization. 2. If there are two refluxes (through the junction and perforator veins), the thrombus formation is towards a more powerful reflux, in the direction of a hemodynamically significant and energetically reflux. 3. Pathological venous blood circulation on the thigh in the great saphenous vein through the insufficient sapheno-femoral junction, through perforator veins on the thigh with venous blood reverse into the femoral vein leads to phlebohypertension in this area and development of the deep vein valve insufficiency. 4. Inclusion into the pathological venous blood circulation the Giacomini vein also causes phlebohypertension with deep vein valve insufficiency.
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