ABSTRACT
The results are presented of 22 reconstructive operations in 22 patients with venous and/or lymphatic oedema of the leg, after a maximum follow-up of three years. An overall patency rate of venous anastomoses of 92% and symptomatic improvement in 75% after lymphovenous anastomoses, indicates that there is a place for reconstruction in a highly selected group of cases. Deep venous insufficiency is diagnosed by transbrachial descending phlebography and direct venous pressure determination. Mixed forms of oedema, i.e. combined venous and secondary lymphatic, frequently occur in patients who have undergone tumour resections and radiotherapy. Both non-invasive plethysmography and routine phlebography via venipuncture on the dorsum of the foot are not reliable in diagnosing mixed oedema. For adequate visualization, direct puncture of the femoral vein in the groin is recommended.
Subject(s)
Edema/surgery , Femoral Vein/surgery , Leg/surgery , Lymphedema/surgery , Adult , Anastomosis, Surgical/methods , Chronic Disease , Female , Humans , Male , Middle Aged , Phlebography , Popliteal Vein/surgery , Popliteal Vein/transplantation , Saphenous Vein/surgery , Saphenous Vein/transplantationABSTRACT
Three patients without prior thrombosis or varicosities presented with decreased venous outflow. They suffered from venous complaints, such as oedema and pain in the leg after prolonged standing. Phlebograms showed no obstruction or hypoplasia. Normal function of calf muscle pump and valves was present at venous pressure determination. The theoretical basis of venous emptying is discussed and a hypothesis is postulated that decreased emptying is due to a change in elastic properties of the venous vessel wall.
