In this literature review, the analysis of the studies of venous blood flow pathology in the inferior Vena cava system using magnetic resonance imaging (MRI) is carried out. Special attention is paid to the attempts made to use this method in the diagnosis of chronic lower limb vein disorders (CVD) through magnetic resonance venography (MRV). Historically and methodically, the gradual introduction of MRV methods in the diagnosis of lower limb vein thrombosis (LEDVT) and venous thromboembolism (VTE) has been shown.Methods of non-contrast MRV based on the effect of blood flow, as in the case of MR-Angiography, are divided into two principal groups: methods based on the amplitude effects of Time-of-Flight (TOF) and methods based on Phase Contrast effects (PC). Techniques for conducting contrast-free MRV are described in detail. Attention is paid to pulse sequences used in the world for visualization of veins in contrast-free MRV in TOF and PC mode (FR-FBI, SPADE, SSFP) and post-processing methods: 2D-TOF MRV FLASH, 2D-TOF MRV CRASS, FIPS, VED, VENS.Contrast-enhanced MRV (CE MRV) is based on the use of “blood pool” contrast agents, which feature the ability to form stable compounds with blood plasma proteins. Worldwidesubstances with magnetic and supermagnetic properties based on gadolinium or iron oxide are used as contrast agents for CE MRV. The result of using these contrast agents is an increase in the quality of visualization due to a better signal to noise ratio (SNR) using 3D image processing (3D CE MRV) using fast sequences: GRE, TFLAS, VESPA, CAT, in conditions of direct and indirect CE MRV.It is noted that in recent years, certain restrictions have been imposed on certain linear contrast agents containing gadolinium in their further use. Therefore, for the purpose of CE MRV, it is efficientl to use only cyclic contrast agents to avoid unnecessary risks.Contrast-free MRV has again received intensive development in recent years, due to the restrictions imposed, one of these methods is direct thrombus imaging (Direct Thrombus Imaging – DTI or Magnetic Resonance Direct Thrombus Imaging - MRDTI) using fast pulse sequences: bSSFP, BBTI, DANTE. The latest research on this LEDVT diagnostic method was published in 2019 and has shown high diagnostic value.For all the most commonly used methods of MRV, specificity and sensitivity are shown.Further MRV in patients with CVD and DVT is a promising diagnostic task in modern phlebology. MRV should be introduced into clinical practice more actively than it is today.
шение функции мышечновенозной помпы голени является важным звеном патогенеза хронических за болеваний вен (ХЗВ) нижних конечностей [7-9]. Яв ляясь по сути системой функциональных единиц, мышечновенозная помпа голени состоит из мио фасциальных образований, сегмента поверхностных,
медицинский Центр «палитра» 1 , г. владимир, российский национальный исследовательский медицинский университет им. н.и. пирогова минздрава россии 2 , г. москва, институт мозга человека им. н.п. бехтеревой, ран 3 , г. санкт-петербург, российская Федерация Цель. провести исследования по использованию цианакрилатного клея «сульфакрилат» для облитерации варикозных вен нижних конечностей у человека.Материал и методы. с целью обоснования возможности использования клеевого соединения «сульфакрилат» была произведена эндовазальная катетерная облитерация притоков и магистральных стволов большой подкожной вены на голени у 15 пациентов с варикозной болезнью (с2 по сеар). клинически оценивалась выраженность болевого синдрома, наличие или отсутствие флебита и тромбофлебита, гиперпигментация, неврологические расстройства, аллергическая реакция. ультразвуковой контроль проводился в различные сроки, начиная с 3-го дня до 6 месяцев. Гистологическое изучение морфологических изменений проводилось выборочно.Результаты. у всех пациентов после введения клея «сульфакрилат» присутствовала клиника умеренного флебита, без образования тромбов в просвете вены. местной или общей аллергической реакции не отмечалось. окклюзированные венозные сегменты начиная с 7-го дня пальпировались в виде тяжей умеренной плотности, без инфильтрации окружающих тканей. ультразвуковое исследование показало при отсутствии кровотока постепенную биодеградацию клеевой полосы внутри вены с развитием полной облитерации просвета начиная с 4-го месяца. при гистологическом исследовании, начиная с 7-го дня, в стенке вены отмечалось постепенно купирующееся асептическое воспаление. моноцитарная инфильтрация венозной стенки с образованием многоядерных клеток инородных тел присутствовала до времени полной биодеградации клея. процесс диффузного разрастания соединительной ткани с наличием фибробластов со стороны субэндотелия и в средней оболочке наиболее активно отмечался в гистологическом материале от 90 до 120 дней с момента окклюзии. в срок 180 дней просвет окклюзированных «сульфакрилатом» вен был полностью облитерирован зрелой соединительной тканью при отсутствии частиц клея, что свидетельствовало о его полной биодеградации.Заключение. проведенные исследования позволяют сделать вывод о потенциальной возможности использования клеевого соединения «сульфакрилат» для проведения эндовазальной облитерации варикозных вен у человека.Ключевые слова: цианакрилатная эмболизация, нетермальная облитерация, нетумесцентная облитерация, эндовазальная облитерация клеем, варикозная болезнь, цианакрилатный медицинский клей «Сульфакрилат» Objective. To conduct clinical experimental studies on the use of cyancrylate glue «Sulfacrylate» (produced in Russia) for obliteration of varicose veins of the lower extremities in humans.Methods. Endovascular catheter obliteration of the tributaries and main trunks of the great saphenous vein on the tibia was performed in 15 patients with varicose disease (C2 to CEAR) in order to substantiate the possibility of using the adhesive compound «Sulfacrylate». Pa...
Plethysmography as a method for studying peripheral circulatory system was first proposed by wletney in 1953. In Russia, the first most significant research studies on the feasibility of plethysmography in studying peripheral blood flow and circulatory physiology taken together were conducted at the St. Petersburg Pavlov Institute of Physiology in 1961. From this time onwards, the possibilities of plethysmography as a non-invasive objective method for the diagnosis of hemodynamic disorders, particularly in arterial pathology, were studied intensively. These parameters were not determined for the venous blood flow, but in 1980s the authors were able to establish plethysmographic criteria not only for various forms of venous pathology, but also for degrees of chronic venous insufficiency using a device significantly improved by V.N. Pavlov and V.E. Maslov.The purpose of this publication is to analyze the literature data on the use of aerial plethysmography and photoplethysmography in the study of hemodynamic disorders in patients with chronic diseases of the veins of the lower extremities. At present, in order to assess the venous blood flow in condition of air plethysmography, indicators of functional venous volume (VV), maximum venous outflow (MVO), venous filling index (VFI), evacuation volume (EV) and residual volume (RV), as well as an integral indicator – residual volume fraction (RVF) are determined in the world. A venous reflux test (VRT) is performed as part of photoplethysmography. The data published today show the high statistical reliability of the comparative analysis and the great scientific significance of the research. According to many foreign authors the use of plethysmographic methods of diagnosis allow to assess violations of venous blood flow in patients with chronic venous diseases of various clinical classes according to CEAP more precisely and to give a global assessment of disorders of the venous outflow from thrombotic occlusion of segmental to hypervolemia in patients with varicose veins in different forms of manifestations of chronic venous insufficiency. The analysis of the literature data allows to make a conclusion about the prospects of further research using these non-invasive methods of evaluation of venous blood flow in the lower extremities.
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