VENOUS HEMODYNAMICS IN ACUTE VARICOTHROMBOPHLEBITIS IN THE GREAT SAPHENOUS VEIN BASIN
Objective. To evaluate the influence of venous hemodynamics in acute varicothrombophlebitis in the basin of the great saphenous vein on the spread of the thrombotic process.
Materials and methods. The analysis of venous hemodynamic disorders in 245 patients with acute varicothrombophlebitis in the basin of the great saphenous vein was performed. The age of patients participating in the study ranged from 19 to 82 years (mean age 52±2,7 years). There were 93 men (38.0%) and 152 women (62.0%). The laboratory and instrumental methods were used for all the patients. They included doppler ultrasound and ultrasound duplex scanning. («ULTIMA PRO–30, zone Ultra», ZONARE Medical Systems Inc., USA).
Results. When AVTF occurred in the GSV basin, all patients showed reflux in the superficial veins of the lower extremities. The ultrasound scanning was performed at the initial examination and immediately before urgent surgery for AVTF. The data of color duplex mapping allowed to reveal certain regularities of venous blood flow disturbance in AVTF and divided patients depending on the state of venous blood flow in the GSV basin into 5 groups. Each of these groups of patients, depending on the prevalence of venous reflux in the GSV pool, was divided into two subgroups: local and widespread reflux. It should be noted, that the conditions for the detection of total reflux in ATVF, with the involvement of GSV in the pathological process, were not due to thrombotic lesions of the latter. When venous reflux was detected, the elasticity and extensibility of the vein wall at the apex of thrombotic masses were evaluated. The ratio of the diameters of the GSV in these positions and the assessment of the "degree of elasticity" by Schwalb PG (2005), which indirectly characterized the state of venous tone were calculated. Venous reflux was assessed on a Valsalva test in vertical and horizontal positions. Venous reflux of blood in the femoral veins was found in 134 (54.7%) patients. At the same time, local reflux was found in 38 (15.5%), and widespread - in 96 (39.2%) patients. It should be noted that the prevalence of venous reflux was directly proportional to its power. Among all groups of patients with acute varicothrombophlebitis, 176 (71.8%) had widespread reflux in the great saphenous vein and 96 (39.2%) in the femoral vein. In 37 (15.1%) patients with acute varicothrombophlebitis revealed a combined nature of reflux, ie the spread of reflux from the superficial venous system not only to the apex of thrombotic masses, but also to the site of horizontal perforation, and reflux from the deep venous system spread through failed perineal veins in the great saphenous vein. Thus, widespread venous reflux was found in 87.3% of patients. In the absence of vertical reflux through the sapheno-femoral cochlea and the presence of an ascending process of thrombosis, it is necessary to identify another source of reflux.
Conclusions. It is proved that the process of thrombosis in acute varicothrombophlebitis depends on the power of venous reflux, the severity of venous discharge through the communicating veins, the state of collateral venous blood flow in venous shunts and basins of large and small subcutaneous venous blood vessels. Venous reflux in the trunk of the great saphenous vein to some extent determines the embolism of the thrombus and participates in its development. Varicose veins of the great saphenous vein and the discharge of blood through incapable permeable veins reduce the power of reflux through the sapheno-femoral cochlea and reduce the rate of thrombosis in the main trunk.
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