[Vertical reflux in lower-limb varicosity: variants, diagnosis, treatment].

Based on thoroughly analysing the findings obtained by ultrasonographic duplex scanning performed on a total of 763 lower limbs in 547 people presenting with various-pattern and different-localization dilatations of the saphenous veins, the author has herein managed to determine that nearly 20% of the examined patients turned out to have no retrograde regurgitation of the blood flow along the vessels concerned, and that in a further 7.3% of the patients, the backward flow of blood appeared to have no communication with the subfascial venous system. To put it otherwise, a vertical reflux in its classical manifestation is not always observed in the presence of the dilated superficial veins of the lower extremities. It turned out that a vertical reflux may be secondary to or result from not only valvular incompetence of the saphenofemoral and saphenopopliteal junctions, which certainly is the case in terms of the perception so deeply rooted in our minds, as a conventionally and rather reasonably considered source of origin, but may also be a consequence of the incompetent venae perforantes of Dodd and those of lateral localization, as well as the communications with the pelvic veins. Amongst the peculiar features encountered herein and worth mentioning was the fact that the vertical reflux could propagate both along the trunk of the great and/or small saphenous veins and along their tributaries only, involving either a part of, or the entire venous vessel all along its length. The obtained findings were later positively reflected in therapeutic decision-making and favourably contributed to carefully assigning and duly delivering appropriate treatment to have eventually consisted in minimally invasive interventions and organ-sparing procedures.

[State of the greater saphenous vein following intraoperative truncal scleroobliteration in varicose disease].

The authors have analyzed the outcomes of intraoperative truncal scleroobliteration of the greater saphenous vein, which was used instead of stripping in patients presenting with varicose disease of the lower limbs. Obtained were three variants of the condition of the vessel concerned following the intervention: complete obliteration, preserved lumen, and alternating portions of obliteration and patency. It was determined that varicosity of saphenous veins and incompetent perforating vein of Dodd were more often encountered in preserved patency of the trunk of the greater saphenous vein on the femur, which required additional treatment. Tested were methods of non-surgical correction of the surgical outcomes by means of echosclerotherapy.

[Application of medical-purpose knitted fabric STRUVA 23 in office surgery for varicosity].

The article proffered herein discusses a possibility of using groin-high stockings STRUVA 23 in women operated on for uncomplicated varicosity of the lower limbs in outpatient conditions by means of modern minimally invasive techniques. Analyzing the postoperative-period course in a total of 15 women making use of conventionally employed elastic bandages, as compared with 20 women wearing the woven medical-purpose stoking pulled on the postoperative leg clearly showed apparent advantages of the latter type of compression, thus enabling the authors to safely recommend the stockings STRUVA 23 for application in office surgery.

[Some aspects of venous surgery based on advanced knowledge of venous anatomy of the lower extremities]. / Nekotorye voprosy flebokhirurgii v svete uglublennykh znanii anatomii venoznogo rusla nizhnikh konechnostei.

Analysis of the errors and faults in the treatment of the main diseases of veins of the vena cava inferior system showed that they can be explained to a great extent by the uncoordinated ideas of the anatomy of the lower limb venous channel. Our experience suggested the expediency of evaluating the condition of venous circulation from the standpoint of comprehensive consideration of the vascular channel structure. The suggested scheme of the structure of the venous channel with all the collaterals and the intravenous connections is systematized and logically completed. We employed it for analysis of some up-to-date problems of the diagnosis and treatment of the most frequently encountered diseases of the lower limb venous system. Knowledge of the general and individual characteristics of the structure of the venous channel opens up new opportunities for their use in surgery and at the same time protect against unreasoned and erroneous decisions.

[Anatomo-topographic basis for operations of transposition of the superficial femoral vein in post-thrombophlebitic disease of the lower extremities]. / Anatomo-topograficheskoe obosnovanie operatsii transpozitsii poverkhnostnoi bedrennoi veny pri posttromboflebiticheskoi bolezni nizhnikh konechnostei.

Post-thrombophlebitic disease of the lower limbs may be occlusive, (2%), recanalized (54%), and mixed (44%) in character. Operations for restoration of the normal flow of blood cannot remove the retrograde flow in veins with destroyed valves. Many variants of valve restoration have been suggested. The simplest among them are transplantation of the superficial femoral vein, the lateral circumflex femoral vein, and the great saphenous vein. The anatomical structure of the lower limb venous system was studied on the corpses of humans without venous pathology. In most cases the deep femoral vein was found to have one valve (46.8%), two (30.6%), and three (12.8%) valves. Valves were found at a distance of 1.0 to 4.5 cm from the site of drainage of the deep femoral vein into the superficial vein in 48.35% of cases, 43.5% had a sufficient diameter (0.6 cm). Thus, implantation of the superficial femoral vein into the deep vein can be conducted in less than half of the patients. Study of the anatomy of the lateral circumflex femoral vein showed that the operation can be performed in 9.6% of cases. The great saphenous vein is the main route of blood drainage in post-thrombophlebitic disease. Its use as a valvular protection is very risky. It should also be taken into account that in post-thrombophlebitic disease the great saphenous vein is dilated and marked by relative venous incompetence. Though they are relatively simple, these operations, can be therefore, performed in less than half of the patients. Examination of patients should include ultrasonic angioscanning and retrograde transfemoral phlebography, which allow precise determination of the anatomical features of the lower limb venous system in each patient.

[The current diagnostic procedure in chronic pathology of the veins of the lower extremities]. / Sovremennaia diagnosticheskaia taktika pri khronicheskoi patologii ven nizhnikh konechnostei.

Stepwise (out- and inpatient) examination forms the basis of diagnostic examination tactics in chronic abnormalities of the veins. Noninvasive ultrasonic methods of studying the venous system are preferred. With the gradual formation of groups of patients with an affection of the veins, invasive isotope and angiographic methods are supplemented. The authors emphasize that such examination of patients in stages raises the efficacy and the quality of diagnosis in individuals with chronic venous abnormalities.

[Ultrasonic examination in the diagnosis of chronic diseases of the veins of the lower extremities]. / Ul'trazvukovoe issledovanie v diagnostike khronicheskikh zabolevanii ven nizhnikh konechnostei.

Noninvasive diagnosis of chronic diseases of the lower limb venous system is an urgent problem of modern phlebology. Ultrasonic examination (USE) makes it possible to judge adequately the condition of the deep and surface veins and, consequently, to improve significantly the management of varicose and post-thrombophlebitic diseases. The authors elaborated an original method for the diagnosis and appraisal of the condition of the lower limb venous system by means of ultrasonic scanning and various functional tests for determining the character of affection of the venous valvular apparatus. Examination of more than 200 patients with primary varicosities and post-thrombophlebitic disease, the use of highly-resolving ultrasonic equipment, and comparison of the results of USE with the findings of radiocontrast phlebography (agreement in 99.8% of cases) allow the conclusion that noninvasive ultrasonic methods must be used widely in appraising the venous status in patients with chronic diseases of the venous system of the lower limbs.

[Surgical anatomy of the posterior tibial veins]. / Khirurgicheskaia anatomiia zadnukh bol'shebertsovykh ven.

An investigation of the posterior tibial vascular plexus has established certain specific features of its structure both in normality and in patients with postthrombotic disease. The alterations found require an individual approach to choice of surgical measures which is finally determined intraoperatively. At the present time surgical interventions on the posterior tibial veins in patients with postthrombotic disease are thought to be of three types: extended resection, extravasal correction and plasty of the posterior tibial veins.

[A present-day approach to surgery for the formation of crossed femoro-femoral shunts in unilateral occlusions of the ilio-femoral venous segment (indications, principles of the surgical technique)]. / Sovremennyi podkhod k operatsiiam perekrestnogo bedrenno-bedrennogo shuntirovaniia pri odnostoronnykh okkliuziiakh podvzdoshno-bedrennogo venoznogo segmenta (pokazaniia, printsipy khirurgicheskoi tekhniki).

As distinct from the classical Palme-D'Esperon operation in which the anastomosis is established with the common femoral vein, the authors prefer to form the anastomosis in the region of the saphenofemoral communication in inadequate drainage in the iliofemoral segment in patients with the postthrombotic disease. Seven variants of crossed femorofemoral shunting (CFFS) were carried out. The anastomoses were formed by means of precision techniques; an operating microscope was used when the anastomosis measured less than 5 mm in diameter. The CFFS was found to be patent in follow-up periods of up to 2.5 years in all cases. From analysis of the late-term results of CFFS, the authors claim that functional block of venous drainage from the femoro-iliac segment, rather than anatomical occlusion, is the indication for this operation.

[Doppler echographic diagnosis in postthrombotic syndrome]. / Doplerograficheskaia diagnostika posttromboticheskogo sindroma.

On the basis of rich experience and the elaborated techniques of study, the authors claim that ultrasonic doppler echography is a highly informative and safe method for the diagnosis of the postthrombotic syndrome of the lower limbs yielding all the necessary data on the condition of the superficial and deep veins. The introduction of this method into the wide practice of out-patient clinics will make it possible to recognize the disease in time and determine its stage and form as well as the indications for operative or nonoperative treatment. The use of highly sensitive apparatuses will allow phlebography, which is still a necessary diagnostic procedure, to be rejected as a more hazardous and costly method.

[Ultrasonic diagnosis of post-thrombotic disease of the lower extremities]. / U'ltrazvukovoe issledovanie v diagnostike posttromboticheskoi bolezni nizhnikh konechnostei.

On the basis of a rich experience and developed techniques of examination the authors claim that ultrasonic scanning is a highly informative and safe method for the diagnosis of postthrombotic disease of the lower limbs which yields all the necessary data on the condition of the deep main veins. With the introduction of this method into wide clinical practice the disease will be diagnosed in time, its stage and form determined, and the performance of phlebography, which is still necessary, will be less frequent.

[Transpopliteal phlebography in the diagnosis of chronic diseases of the veins of the lower extremities]. / Chrespodkolennaia flebografiia v diagnostike khronicheskikh zabolevanii ven nizhnikh konechnostei.

From experience in 98 studies the authors claim that transpopliteal phlebography yields information on the condition of the popliteal and the tibial veins and the ostial valve of the small saphenous vein in retrograde, and on the condition of the femoral vein in antegrade administration of the radiocontrast medium. It is indicated for patients suffering from varicosity in ectasia of the popliteal and tibial veins, as well as when the results of clinical tests for competence of the valves of the small saphenous vein are doubtful. The absence of visualization of the femoral vein in ascending distal or retrograde femoral phlebography in patients with congenital venous dysplasia or with phlebothrombosis sequelae is an indication for antegrade transpopliteal phlebography.

[The role of changes in venous capacity in the lower extremities in the pathogenesis of post-thrombotic disease]. / Rol' izmenenii venoznoi emkosti nizhnikh konechnostei v patogeneze posttromboticheskoi bolezni.

From the results of examination of 91 patients with postthrombotic disease by radioindication methods the authors established that blood filling of the lower limbs increases in a horizontal position. Varicosity leads to further growth of regional blood volumes (RBV). No essential difference was revealed in blood filling in the recanalized and mixed forms of the postthrombotic disease. The increase of blood volume as compared to the initial value in these patients in an orthostatic position is below normal. Storage of blood in the lower limbs causes increase of the circulating volume (CV) at first, but after 5 years of the disease it leads to gradual reduction of the CV and increase of RBV. Excessive blood filling in the postthrombotic disease causes diminution of the resilient-elastic properties of the vein, makes the work of the muscular-venous pump of the leg difficult, and leads to microcirculatory disorders. Combined treatment for the purpose of removing the principal links of the pathogenesis is suggested.