[Lymphatic complications from variceal surgery]. / Complications lymphatiques de la chirurgie des varices.

INTRODUCTION: Lymphatic injuries are unavoidable during varicose vein surgery. However these injuries seldom lead to complications. This study was held to try to find an explanation to this contradiction which seems to be only noticeable. MATERIAL AND METHOD: If anatomy shows that it is impossible to operate on varicose veins without injuring lymphatic vessels, the regeneration power of these latters, known for a long time, is such that complications due to these injuries are all the more exceptional that surgeries are less traumatizing than it used to be. Nowadays, each surgeon is only faced to a small number of such complications during their career. This rareness makes a methodical personal study quasi-impossible. That is why we sent a questionnaire to about thirty surgeons specialized in this field. This questionnaire, about their experience, dealt with lymphatic complications they had met during varicose veins surgery. RESULTS: Twenty three answers were sent in time and deal with more than 184,000 surgeries. The lymphatic complication rate is about 8.7%, 5.4% of which are lymphorrhea, 2.6% of lymphocele, 1.09% of lymphangitis and 0.5% of lymphoedema. Of course, these figures are approximate. Lymphoedema is the only long-lasting lymphatic complication of the varicose veins surgery. CONCLUSIONS: According to us, sclerotherapy seems to be more effective than surgery, in case of signs, even benign, of lymphatic insufficiency.

[Distal obliterating arteriopathy of the lower limbs in a systemic disease. Treatment with normovolemic hemodilution. [Report of one case]]. / Artériopathie oblitérante distale des membres inférieurs dans le cadre d'une maladie de système. Traitement par hémodilution normovolémique [à propos d'un cas].

The authors report on a 31 year old man with a generalised illness consisting of: buccal aphthous ulcers, distal arteriopathy, multiform cutaneous lesions (necrotising vasculitis, folliculitis, nodules), hypersensitivity at the site of puncture, Raynaud's syndrome and superficial venous thromboses. After the failure of various therapies (calcium heparin, ticlopidine, colchicine, corticoids, immunostimulants), the patient was successfully treated by normovolemic haemodilution on 20 occasions, obtaining each time healing of the skin lesions within 2 to 4 weeks.

[Evaluation of the results of a sclerosing treatment. Concordance between 2 examiners]. / Evaluation du résultat d'un traitement sclérosant. Concordance entredeux examinateurs.

With the aim of determining criteria by which results of a sclerosant treatment could be assessed in a multicentric study, 35 sapheno-femoral junctions (26 long saphenous veins and 9 short saphenous veins) treated by sclerotherapy beforehand, were controlled separately and confidentially by two examiners, first clinically, then using the Doppler. The concordance rates were analysed for each of the tests carried out: fascial palpation, clinical and ultrasound percussive permeability, clinical and ultrasound search for reflux, measurement of length of reflux. The results confirm the superiority of the Doppler technique, both in the diagnosis of ostial permeability and reflux (concordance superior at 90% as opposed to 68 to 80% for the clinical tests), and in the quantification of the reflux (strong positive correlation, r = 0.83, between the values given by the two examiners). The doppler technique provides an excellent concordance of differentiated clinical sensibility between the examiners. The permeability, by Doppler, and the length of the audible reflux are proposed as criteria for assessment of the result of a sclerosant treatment, during the follow-up.

[Role of grafts in the treatment of resistant ulcers]. / La place de la greffe dans le traitement des ulcères rebelles.

Despite a correction as complete as possible of the venous stasis, certain ulcers prove resistant to treatment. In these cases, grafts, whose active mechanism is still not well known in many respects, can turn out to be effective.

[Sclerotherapy of perforating veins. Technics, doses]. / La sclérothérapie des perforantes. Techniques, doses.

The majority of perforating veins react to the sclerosant treatment in the same way as the neighbouring varicose veins. The sclerosant treatment is therefore carried out in the majority of cases as if they did not exist. But in 15% of essential varices, and in 21% of post-phlebitic varices, it is altogether different. The dose of the product necessary to achieve sclerosis of these haemodynamically significative perforators (H.S.P.) is going to be 30% or more above the dose necessary to achieve sclerosis of the neighbouring varicose sections. This relative sclero-resistance often tallies with the other methods of revealing an incontinent perforator.

[Ankylosis of the ankle and intractable post-phlebitic ulcer]. / Ankylose de la cheville et ulcère post-phlébitique rebelle.

One of the causes of the intractable nature of some leg ulcers is the stiffening, then the ankylosis of the ankle. The consequences of the ankylosis are secondary to the physiology of walking by suppression of the muscular pump of the calf and that of the foot. The treatment must be preventive and this is possible only if ankylosis is systematically looked for in every longlasting leg ulcer.

[Long-term normovolemic hemodilution in refractory postphlebitic ulcers]. / L'hémodilution normovolémique durable dans les ulcères post-phlébitiques rebelles.

Thrombo-embolic complications are still amongst the most serious encountered in surgery and in certain medical afflictions, despite the different forms of prophylaxis, and in particular subcutaneous heparin. Thus, in 1983, an investigation by Salleras in Barcelona based on 37,400 cases, assessed the incidence of these complications after surgery at a rate of 2.5%. That is why post-phlebitic syndromes, the results of late diagnosis at the acute stage and/or inappropriate treatment, are disorders which are still very widespread, chronic, and more or less incapacitating. At the root of tissue modifications and trophic disorders which are seen in the post-phlebitic illness, a state of venous stasis at the periphery of the limbs is very often encountered; it depends on the following processes: the obstruction of a large venous collector (obstructive syndrome), the size of the stasis depending on the functional value of the anastomotic channels; the insufficiency of the superficial network; orthostatic reflux in the repermeabilized deep veins whose valvular system has broken down. The main trophic complications are: oedema, hypodermatitis and leg ulceration, which is the most formidable complication and which still occurs very frequently. Most post-phlebitic ulcers heal after a well-executed phlebological treatment on an ambulatory basis. A certain number of these ulcers prove, however, to respond badly to ambulatory treatment; they are called resistant post-phlebitic ulcers. By definition, they are difficult to cure; however, it has recently been apparent that the classical treatments associated with long-term isovolaemic haemodilution are more effective and enable healing to take place by treating the venous stasis and the increased blood viscosity.

[A case of dysfibrinogenemia complicated by hemorrhage and thrombosis]. / Observation d'une dysfibrinogénémie se compliquant d'hémorragie et de thrombose.

There are, as well as the more common coagulopathies such as deficiency in antithrombin III or Protein C, certain rare disorders complicated simultaneously by haemorrhage and thrombosis--such as dysfibrinogenemia--which can present very special therapeutic problems.

[The anterior saphenous veins of the thigh]. / A propos des saphènes antérieures de cuisse.

The authors base their argument on a homogeneous series of 75 patients who, in the course of crossectomies and the stripping of the long saphenousvein carried out by the authors, were given a puncture-phlebectomy of the accessory anterior saphenous vein or veins. Firstly they analyse the clinical characteristics of the incompetence of these veins in the 75 patients. Then, in the discussion, they carry out a closer study of the anterior saphenous veins in the thigh, which have their own anatomical, physiopathological, clinical, and therapeutic characteristics. Without mistaking the role of complementary sclerosis in these cases, they affirm that reliable results are more difficult to obtain with this sort of vein and they suggest peroperative puncture phlebectomy as the results of this seem very encouraging.

[A new therapeutic approach in persistent postphlebitic ulcers]. / Nouvelle approche thérapeutique des ulcères post-phlébitiques rebelles.

Most post-phlebitic ulcers heal after a well-executed phlebological treatment on an ambulatory basis. The time it takes to heal is, on average, longer than that normal in the case of varicose ulcers. A certain number of post-phlebitic ulcers prove, however, to respond badly to the ambulatory treatment. In these cases the procedure described by the authors enables healing to take place by treating the venous stasis and the blood viscosity.

[The external saphenous artery. Preliminary remarks on its importance in phlebology]. / L'artère saphène externe. Remarques préliminaires sur con intérêt en phlébologie.

An arterial branch, companion of the external saphenous artery, has been described on rare occasions by anatomists. Certain exceptional complications of sclerosant treatment of the varicose external saphenous vein can only be explained by accidental injection of this arteriole. The accidental injection produces cutaneous ischaemia of variable severity and sometimes a partial muscular ischaemia, usually of the internal gemellus. Certain precautions should be taken in order to avoid such an accident. Curative treatment involves both immediate actions and a secondary treatment.