Deep vein reflux: An assessment by descending phlebography

Ackroyd, Jenny S.; Thomas, M. Lea; Browse, N L

doi:10.1002/bjs.1800730112

Cited by 30 publications

(3 citation statements)

References 4 publications

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“…There has been a reported poor association between popliteal reflux as detected by descending venography, and skin changes and ulceration. 66 This is because it is known that skin changes and ulceration can often occur in the presence of reflux in the superficial veins only, 43,67,68 but competence at the level of popliteal vein does not exclude postthrombotic reflux in the tibial veins. 69 With the development of CFDI, descending venography is no longer necessary unless surgical reconstruction is being considered.…”

Section: Ascending Venographymentioning

confidence: 99%

The Role of Hemodynamic Measurements in the Management of Venous and Ischemic Ulcers

Lazarides

Giannoukas

2007

The International Journal of Lower Extremity Wounds

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There is a need for quantitative investigations in the vascular laboratory to manage lower extremity ulcers. The majority of leg ulcers are of venous (45%-60%) or arterial origin (10%-20%). Despite the increasing complexity of new devices used in vascular surgical practice, the anklebrachial pressure index (ABPI) remains the cornerstone for the differential diagnosis of ischemic ulcers. The toe-brachial pressure index and the pole test represent attractive alternative tests especially in patients with diabetes. Color flow Doppler imaging (CFDI) is advantageous over ABPI in cases in which wounds and ulcers prevent the use of a cuff by virtue of their size or location; additionally CFDI technology can detect nonflow limiting lesions, lesions to nonaxial arteries such as the deep femoral artery, or lesions limited to a single tibial artery. Continued improvements in the accuracy of CFDI have prompted some vascular surgeons to replace contrast arteriography in distal bypass procedures. Transcutaneous partial oxygen tension measurement (TcPO(2)) is another noninvasive method that is reliable to select the level of amputation and recommended to determine tissue viability in critically ischemic limbs and in the management of the diabetic foot. CFDI has revolutionized the diagnostic approach to venous disorders and it is considered the gold standard for the assessment of the venous system of the lower limb, causes minimal inconvenience to patients, and is easily repeatable, but it is considered highly operator dependent. Various plethysmography techniques are of limited application in ulcer investigations, because of their difficulty to calibrate signal, unless time measurements such as the postexercise refilling time are used.

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Section: Ascending Venographymentioning

confidence: 99%

The Role of Hemodynamic Measurements in the Management of Venous and Ischemic Ulcers

Lazarides

Giannoukas

2007

The International Journal of Lower Extremity Wounds

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“…Descending venograms with a Valsalva maneuver [15][16][17] are of value to establish the functional state of valves in the deep veins of the leg. These studies are of value in postthrombotic patients to document the location and distribution ofpostthrombotic destruction of valves [3,18].…”

Section: Special Investigationsmentioning

confidence: 99%

“…No procedure used for the management of the postthrombotic syndrome can be used in isolation. The pathological anatomy must be thoroughly demonstrated by a dependable method of ascending venography, supplemented where necessary by descending venography, and by appropriate noninvasive studies [16][17][18],…”

Section: Management In the Early Stagementioning

confidence: 99%

Development of the postthrombotic syndrome: Its management at different stages

Halliday

1990

World j. surg.

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The postthrombotic syndrome consists of clinical features which follow thrombosis of deep venous return of the limb. Patterns of postthrombotic changes remain difficult to predict and once established, difficult to contain and reverse. Following a thrombotic event of the lower limb, 3 clinical stages can be observed which may be followed by intervening quiescent intervals. Stage I, or the early phase, is characterized by the residual obstructive process following acute venous occlusion. This can be manifested by either a bursting type of pain (venous claudication) or edema of the leg. A thrombotic process can involve the calf veins, thigh veins, pelvic veins, or any combination of the three. Specific clinical syndromes develop depending on the venous pump system involved. The venous pump system consists of the plantar calf pump and the thigh pump. These serve to propel blood upward. Involvement of any one or more of the 3 in the thrombotic processes can result in a relative obstruction with a specific pattern of clinical symptoms. Optimally, the venous thrombotic process should be treated during this early phase to prevent the subsequent events which may render the process irreversible. The second stage of the postthrombotic syndrome consists of the development of fat sclerosis. At this stage, the process becomes progressively irreversible as the extravasation of fibrin into the interstitial space results in progressive fibrosis and sclerosis. This results in damage to the skin and subcutaneous tissues which render the process irreversible. Specific treatment, while still introducible at this stage, can halt the progress of the syndrome, but rarely results in complete reversal.(ABSTRACT TRUNCATED AT 250 WORDS)

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Changes in the apparently normal limb in unilateral venous ulceration

Stacey

Burnand

Pattison

et al. 1987

Journal of British Surgery

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Forty-seven patients with unilateral venous ulceration have been investigated to determine if any abnormalities were present in the contralateral limbs which had not had lipodermatosclerosis or ulceration. Ascending phlebography in the non-ulcerated limbs showed post-thrombotic changes in 28 per cent and incompetent lower leg communicating veins in 19 per cent. This incidence was not significantly different to the limbs with healed ulceration (45 and 23 per cent respectively, chi 2 test, P = 0.10). Half volume refilling time measured by foot volumetry suggested that 79 per cent of the non-ulcerated limbs had evidence of deep vein incompetence or incompetent lower leg communicating veins, which was again similar to the incidence in the previously ulcerated limbs (85 per cent). Transcutaneous oxygen readings, expressed as a ratio of a reading at a standard site in the gaiter region of the leg over a reading from the upper arm, were significantly lower in non-ulcerated limbs (mean 0.84 +/- 0.26 s.d.) than in a cohort of age and sex matched controls (mean 1.02 +/- 0.14, Student's t test, P less than 0.001), and significantly higher than in previously ulcerated limbs (mean 0.68 +/- 0.31, P less than 0.01). Abnormalities in venous anatomy and function have been shown, in conjunction with evidence of reduced oxygen diffusion, through the gaiter skin before overt skin changes develop.

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Deep vein reflux: An assessment by descending phlebography

Cited by 30 publications

References 4 publications

The Role of Hemodynamic Measurements in the Management of Venous and Ischemic Ulcers

The Role of Hemodynamic Measurements in the Management of Venous and Ischemic Ulcers

Development of the postthrombotic syndrome: Its management at different stages

Changes in the apparently normal limb in unilateral venous ulceration

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