ABSTRACT
Acute lower limb varicophlebitis is generally considered as a nonhazardous condition. In spite of that notion, acute ascending varicophlebitis (AAVP) involving proximal part of saphenous trunks with propagation of thrombus into deep veins may cause life-threatening complications--deep vein thrombosis and pulmonary embolism. Difficulties in AAVP diagnosis in elderly individuals account for untypical insidious clinical presentation and inadequate interpretation of symptoms by patient. Duplex scanning of lower limb veins is one of the most valuable diagnostic tools that influence the management of patients with AAVP. Elderly age is not a contraindication for surgery in patients with AAVP. Ligation of SFJ (SPJ) constitutes the main operative step, preventing progression of thrombosis and PE. In the absence of marked local inflammation at the site of thrombosed veins, varicosities may be removed simultaneously using minimally invasive techniques--perforating inversion saphenous stripping and hook phlebectomy. Further management of elderly patients with thrombosed vein recanalization is specified according to clinical findings and duplex scanning of the veins.
Subject(s)
Varicose Veins , Acute Disease , Age Factors , Aged , Female , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Ligation , Male , Middle Aged , Minimally Invasive Surgical Procedures , Pulmonary Embolism/etiology , Risk Factors , Ultrasonography, Doppler, Duplex , Varicose Veins/complications , Varicose Veins/diagnosis , Varicose Veins/diagnostic imaging , Varicose Veins/prevention & control , Varicose Veins/surgery , Venous Thrombosis/etiologyABSTRACT
In this article we summarize our experience of combined treatment policy used in 213 patients with venous ulcers. The majority of patients (162 persons, 76%) was of elderly age. After preoperative conservative preparation of ulcers, 140 patients were subsequently operated. In elderly patients with many comorbidities and marked indurative lipodermatosclerosis a single-step operation may not be reasonable or technically feasible. 86 patients (57.7%) from the above-mentioned group were operated in 2 (or more) stages. Minimally invasive operative interventions were performed under local anesthesia at the first stage with the aim of eliminating vertical venous refluxes into superficial varicose veins. In delayed period (after 2-6 months) patients underwent operative ligation, endovenous laser coagulation or ultrasound-guided sclerotherapy of incompetent perforating veins. Data obtained from our experience reflect the safety and high effectiveness of staged combined management using minimally invasive operations under local anesthesia, endovenous laser ablation and microfoam sclerotherapy in prevention of embolic complications in patients with trophic ulcers.
Subject(s)
Leg/blood supply , Varicose Ulcer/therapy , Venous Insufficiency/complications , Adult , Age Factors , Aged , Aged, 80 and over , Anesthesia, Local , Embolism/prevention & control , Female , Humans , Laser Coagulation , Ligation , Male , Middle Aged , Minimally Invasive Surgical Procedures , Preoperative Care , Sclerotherapy , Stockings, Compression , Ultrasonography , Varicose Ulcer/classification , Varicose Ulcer/diagnostic imaging , Varicose Ulcer/surgeryABSTRACT
The roentgenological, endoscopic and combined methods of examination of patients allowed to make a program of treatment of patients by the method of bougienage. Different techniques of bougienage were used: "blind", by the direct thread, under the endoscopic control, endoscopic dissection supplemented by bougienage. A stable clinical effect was obtained in the overwhelming majority of patients.
Subject(s)
Burns, Chemical/therapy , Cicatrix/therapy , Esophageal Stenosis/therapy , Burns, Chemical/complications , Burns, Chemical/diagnosis , Chronic Disease , Cicatrix/chemically induced , Cicatrix/diagnosis , Dilatation/methods , Esophageal Stenosis/chemically induced , Esophageal Stenosis/diagnosis , Esophagoscopy/methods , Fiber Optic Technology , Humans , Remission InductionABSTRACT
On the basis of investigations of the acid-formation and motor activity of the stomach in 95 patients with cardiospasm and results of the treatment of 50 of them the author has shown that most of the patients with cardiospasm had an increased acid-formation and a delayed gastric evacuation. Correction of these disorders in addition to routine methods of treatment of cardiospasm gives better early and late results.
