[Site of phlebographically determined venous changes in postphlebitic syndrome with varicose ulcer]. / Etagenverteilung phlebographisch erfassbarer Venenveränderungen beim postthrombotischen Syndrom mit Ulcus cruris.

In 207 legs with venous leg ulcers and postthrombotic syndrome proved by phlebography, the frequency of involvement of the 4 levels of deep venous system was assessed. Level A: deep veins of the lower leg. Level B: poplieal vein and gastrocranial veins. Level C: femoral veins. Level D: iliac veins. Our investigations showed that in 35% damages of the deep veins only in level A (lower leg) were responsible for venous ulcer. In cases with combinations of levels, Level A in 95% also was involved. One can say that postthrombotic leg ulcer correlates above all with the pathomorphological alterations of the lower leg veins.

[Excision of perforating veins]. / Perforantesdiszision.

Excision of perforating veins is performed under local anesthesia and approached through a 10 to 15 mm incision. The superficial vein and the perforator are prepared and excised with scissors. Digital compression instead of ligatures is applied to arrest bleeding. No sutures, but wound closure strips. A strong compression bandage is then applied. Adverse effects are rare and not severe. The resulting scars are bare noticeable. Long term results are satisfactory compared with other radical procedures. The operation only takes a few minutes and is also recommended in daily phlebological practice.

[Chronic insufficiency of leg veins and aging]. / Chronische Beinveneninsuffizienz und Alter.

We report on chronic venous insufficiency in elderly patients. Our study is based on observations and data obtained in a phlebologic ambulance. As affliction with chronic venous insufficiency seems to depend on social conditions, clinical diagnostics and therapy should be adapted to the situation of the aging and geriatric patient.

[Importance and indications for Doppler ultrasonic diagnosis in chronic venous insufficiency]. / Bedeutung und Indikation der Doppler-Ultraschalldiagnostik bei chronischer venöser Insuffizienz.

Ultrasonic Doppler-technique is a non-invasive, low-cost method to answer some questions regarding venous flow of leg and pelvis in chronic venous insufficiency. Findings can be evaluated immediately. In the diagnosis of a deep venous obstruction in the lower extremity the reliability of the method decreases from proximal to distal. Compared with X-ray or isotopic phlebography the Doppler-technique gives the most accurate results in the examination of pelvic vein flow. The assessment of vein flow is less reliable in the thigh and particularly in the calf. Doppler-technique is also helpful for the detection of incompetent perforator veins of the leg. The results compete with those of phlebography. Systolic blood pressure measurement at the ankle by Doppler-technique is a simple procedure of high value for diagnosing an arterial obstruction of the lower limb.

[The localization of postthrombotic changes in the different levels of the venous system of the leg (author's transl)]. / Die Etagenlokalisation postthrombotischer Venenveränderungen.

In 173 legs with crural ulcers and postthrombotic syndrome proved by phlebography the frequency of involvement of the 4 levels of deep venous system was assessed. The results were compared with those obtained from a group of patients with acute or subacute deep vein thrombosis. The partly very distinct discrepancies may probably be explained by long lasting dynamics of the venous changes (spontaneous lysis, recurrent thrombosis). For the development of severe signs of venous insufficiency the involvement of the lower leg level may be the only cause in many instances.