Objective To evaluate the surgical effects of indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose veins stripping on primary deep venous valvular incompetence of the lower limb.Methods Seventy-eight patients (92 limbs) with primary deep venous valvular incompetence of the lower limbs received the operations of indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose veins from 1997 to 2004. There were 65 males and 13 females, and their ages ranged from 32 years to 72 years (mean age of 52.5 years). The valvular reflux grades of these 92 limbs varied from Ⅲ to Ⅳ according to Kistner’s standard. A sleeve made from the stripped great saphenous vein was used in the indirect loop valvuloplasty of the superficial femoral vein. The early results of surgery were retrospectively analyzed. Results Pre-operative symptoms, such as edema, ulceration, pigmentation and heavy feeling of the performed limbs disappeared or were remarkably improved in 65 cases (76 limbs) after operation. Eight cases (10 limbs) had alleviative symptoms compared with pre-operative ones. Meanwhile, no improvement of symptoms was observed in 3 patients (4 limbs). Acute ilio-femoral vein thrombosis occurred in 2 patients (2 limbs), which manifested as more servious edema of the lower limbs than those before operation. The overall effective rate of surgery was 93.5%（86/92）, and the complications rate was 2.2% (2/92). Conclusion Indirect loop valvuloplasty of the superficial femoral vein plus superficial varicose vein stripping is an effective and convenient way to correct the primary deep venous valvular incompetence of the lower limb. The surgical indications of this disease should be emphasized strictly to assure the good outcomes.
目的 评估应用股浅静脉第一对瓣膜环缩术治疗原发性下肢深静脉瓣膜功能不全的疗效。 方法 对原发性下肢深静脉瓣膜功能不全的40例患者（共45条下肢）施以股浅静脉第一对瓣膜环缩术，环缩材料选用7-0或6-0无损伤缝线。 结果 经上述治疗后，全组病例术后随访2～24个月，临床症状均明显缓解。彩超复查88.6%（31/35）的患肢瓣膜无返流发生。 结论 股浅静脉第一对瓣膜环缩术是治疗原发性下肢深静脉瓣膜功能不全比较理想和有效的方法。
【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.
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.
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.
目的 探讨戴戒术治疗下肢原发性深静脉瓣膜功能不全的疗效和手术经验。方法 35例(47条肢体)下肢原发性深静脉瓣膜功能不全采用GoreTex人造血管行戴戒术治疗，在股浅静脉最高位第一对瓣膜下缩小原静脉周径1/4～1/3。结果 术后随访6个月至2年半，所有患者症状和体征完全或基本消失，9条肢体慢性溃疡于手术后8周内愈合。结论 该手术简便、安全易掌握，疗效满意，为提高本手术效果，应做到： ①熟悉掌握本术式的技术要点； ②合理掌握手术适应证和手术时机。
The clinical results of one-staged indirect valvuloplasty of the superficial femoral vein by wrapping an autogenous saphanous vein cuff to treat 20 patients with primary valvular incompetence of deep vein. The results following postoperative follow-up were 16 patients ahd striking improvement, excellent improvement in 2. venuos thrombosis in 1 and one failure. The operative procedure was introduced, the indications for operation was discussed, and the results were vealuated.
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.
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.