[Ultrasound study before surgery of varicose veins]. / Ultraschalluntersuchung vor Varizenchirurgie.

Ultrasonographic investigation of the various forms of chronic venous insufficiency has substantial advantages compared to diagnosis with the competing phlebogram, particularly preoperatively. Important details such as side branches in the region of the groin, course variations of the small saphenous vein and insufficiency of the perforators in the lower leg are sometimes missed in the antegrade phlebogram. However, it is absolutely necessary to take these into consideration in order to attain a substained good result of surgery. With adequate qualification of the investigator and using all ultrasound techniques, diagnosis by sonography is better than by means of antegrade phlebogram. There are clear specifications for the documentation. With regard to costs and time required, ultrasonographic investigation of chronic venous insufficiency is superior to the antegrade phlebogram and can be repeated at any time.

Effect of different compression therapies on the reflux in deep veins with a post-thrombotic syndrome.

BACKGROUND: Reflux in deep veins is an important pathophysiological factor of post-thrombotic syndrome which can be demonstrated by colour-coded duplexsonography. This study investigates the effect of different compression therapies on the reflux velocity in deep veins in patients with a post-thrombotic syndrome. PATIENTS AND METHODS: Sixty patients with a post-thrombotic syndrome-confirmed by phlebography, in the deep veins of the calf and the thigh were investigated in two groups: In group A, 30 patients (mean age 58 +/- 10 years) received compression stockings (calf compression class II and III, thigh compression class II) and in group B 30 patients (mean age 58 +/- 14 years) received a Sigg short traction bandage of the calf. The velocity at the time of the greatest reflux in the popliteal vein was determined as reflux parameter with the colour-coded duplex sonography using a cuff applied at the calf. All patients stood upright and were measured with and without different kinds of compression therapies. The reflux velocities were graded as low, moderate and high. RESULTS: A significant decrease of the reflux velocity by about more than 45% with compression therapy was found in both groups. The decrease of the refluxes in group A (mean 47.9%) did not differ significantly from the decrease of refluxes in group B (mean 55.8%). The greatest decrease of the reflux velocity under compression therapy was found in high-grade refluxes in both groups. CONCLUSION: A significant decrease of the reflux velocity in post-thrombotic syndrome can be readily demonstrated with different kinds of compression stockings as well as with bandages by means of colour-coded duplex sonography.

[Characterization of post-thrombotic reflux with color-coded duplex ultrasound diagnosis]. / Die Charakterisierung des postthrombotischen Refluxes mittels farbcodierter Duplexsonographie.

Reflux in deep veins is accepted as the most important pathophysiologic phenomenon in postthrombotic syndrome. The data proved by colour coded duplex sonography are demonstrated in this summary. As the different methods to provoke reflux yet are not examined we present our own results. A velocity of more than 10 cm/sec. at the time of the greatest reflux, a duration of reflux of more than 2 seconds and the lack of the valve signal are the best criteria to detect and quantify a postthrombotic syndromE by colour coded duplex sonography. Using Valsalva's maneuver, calf compression and cuff compression test to provoke reflux, the cuff compression technique proved to be the best one.

[Ultrasound diagnosis in post-thrombotic syndrome. Comparative study with color duplex, cw-Doppler and B-image ultrasound]. / Ultraschalldiagnostik beim postthrombotischen Syndrom. Vergleichende Untersuchung mittels Farbduplex, CW-Doppler und B-Bildsonographie.

UNLABELLED: Comparison of colour-coded Doppler sonography, CW-Doppler and real time sonography in the diagnostics of the postthrombotic syndrome. METHOD: Colour-coded Doppler sonography, CW-Doppler and real time sonography were studied in 40 legs with postthrombotic syndrome, confirmed by phlebography. In a further step deep veins of patients with primary varicosis (n = 40) and a group of normal veins (n = 40) where compared with the postthrombotic group (n = 40). RESULTS: The sensitivity of CW-Doppler was 71.2% and that of real time sonography 67.5%, their specificity 92.3% and 92.2%, respectively, while colour-coded Doppler sonography had a sensitivity of 90.9% and a specificity of 88.9%. In addition, colour-coded Doppler sonography in combination with measurement of the peak velocity of venous reflux in deep veins had the highest sensitivity with 92.8% and specificity with 95.4% of all ultrasound methods tested. By means of colour-coded Doppler sonography together with measurement of the peak velocity of venous reflux, healthy persons and patients with varicosis could be distinguished with high significance (p < 0.003) by a peak velocity of venous reflux of more than 10 cm/s. CONCLUSION: In comparison to real time sonography and CW-Doppler, quantitative analysis of reflux in the deep veins by means of colour-coded Doppler sonography is the most valid ultrasound method in the diagnosis of postthrombotic syndrome.

[The value of measuring reflux by color duplex in post-thrombotic syndrome]. / Die Bedeutung der Refluxmessung mittels Farb-duplex beim postthrombotischen Syndrom.

Until now, the diagnosis of the postthrombotic syndrome is based upon venography. This study compares the diagnostic value of the CW-Doppler with the sonographic signs in the deep venous system observed in B-mode sonography and with the quantitative measurement of venous reflux by color Doppler sonography. 84 venous sections of 21 patients with phlebographically diagnosed PTS and substantial clinical signs were examined. CW- Doppler and B-mode sonography did not show significant differences compared to phlebographic findings. Color doppler sonography, however, showed signs which significantly went beyond those seen in venography.

[Doppler ultrasound study in patients with post-thrombotic syndrome: a screening method]. / Doppler-Ultraschalluntersuchung bei Patienten mit postthrombotischem Syndrom: Eine Screeningmethode.

Doppler ultrasound has been a useful, noninvasive technique in the diagnosis of deep venous thrombosis. Until now, primary or secondary varicosities could only be clarified through phlebography or strain-gauge plethysmography. The aim of our study was to assess the flow time in 28 patients with primary varicose veins and postthrombotic syndrome using Doppler ultrasound. The Wilcoxon-Test was used for statistical reviewing in the second test, revealing a significant difference between both groups. The confidence intervals did not overlap.

[Improvement in noninvasive diagnosis of the greater and lesser saphenous vein insufficiency with duplex sonography]. / Verbesserung der nichtinvasiven Diagnostik der V. saphena magna- und der V. saphena parva-Insuffizienz durch die Duplex-Sonographie.

When compared with the phlebogram, the duplex examination proves to be a suitable procedure for diagnosing the incompetence of the junction of the long saphenous vein and of the short saphenous vein. The sensitivity and the specificity of the duplex at the junction of the long saphenous vein amounts to 0.96 and 0.75 respectively and at the junction of the short saphenous vein they are 0.90 and 0.67 respectively.

[Alternative vascular approaches in transluminal angioplasty of infra-inguinal arteries]. / Alternative Gefässzugänge bei der transluminalen Angioplastie infrainguinaler Arterien.

61 procedures using an alternative vascular access for PTA are reported. Puntures of mid and distal femoral arteries and popliteal arteries in antegrade as well as retrograde direction have been proven effective and sufficiently safe, when unfavourable anatomic situations did not allow the performance of a standard procedure. 14 cases necessitated puncture of and access via crural arteries.

[Mobilization following deep venous thrombosis of the leg]. / Mobilisierung nach tiefer Beinvenenthrombose.

A simple score for mobilisation of patients with deep venous thrombosis of the leg is proposed. By this score the significantly earlier mobilisation of patients with deep venous thrombosis is possible without risk.

[Possibility of errors in conventional Doppler sonography of the carotid arteries]. / Irrtumsmöglichkeiten bei konventioneller Dopplersonographie der Carotiden.

Results of Doppler sonography and angiography were compared in 100 consecutive patients with ischaemia in the area of carotid arterial supply. In 15 there were important differences. Three Doppler "occlusions" were angiographically demonstrated to be carotid arterial stenoses; significant additional information was provided by angiography in two patients with stenoses at the origin of the internal carotid artery, while in ten--despite unremarkable Doppler findings--angiography revealed disease in the carotids.

[Critical assessment of light reflection rheography. Comparative studies of phlebodynamometry using invasive measurement of venous pressure, photoplethysmography and light reflection rheography]. / Zur Kritik der Licht-Reflexions-Rheographie. Vergleichsuntersuchungen zur Phlebodynamometrie mittels blutiger Venendruckmessung und Photoplethysmographie sowie Licht-Reflexions-Rheographie.

In chronic venous insufficiency, phlebodynamometry by invasive venous-pressure measurement demonstrates a reduced pressure drop and an accelerated pressure rise, resulting from the action of the ankle-joint-calf muscle "pump". On the other hand, light-reflexion rheography and photoplethysmography can measure only the duration of the refilling period. Simultaneous measurements were made on 47 legs after phlebography (normal: 8; side-arm varicosities: 17; long-saphenous insufficiency: 15; postthrombotic syndrome: 7). Refilling time by photoplethysmography correlated better with that measured invasively than by light-reflexion rheography. Refilling half-time cannot be measured accurately with either noninvasive method. Sclerosing treatment of single side-branch varicosities in ten legs demonstrated that merely measuring refilling time (invasively or noninvasively) was not sufficient, because this value did not indicate any improvement in haemodynamics even after successful treatment.

[Oxygen pressure fields in ulcers of the lower leg]. / Sauerstoffdruckfelder in Unterschenkelgeschwüren.

Using a multi-wire surface electrode, oxygen pressure fields were determined in leg ulcers of 11 patients with chronic venous insufficiency (cvi). In three of them, cvi was combined with arterial occlusive disease. The histograms of all patients with very low PO2 values revealed microcirculatory disturbances of the ulcer tissue. The influence of leg position is reflected in the histograms. Patients with cvi showed higher PO2 values when the leg was raised in comparison with when it was in the hanging position. The patients with mixed ulcerations showed a significant increase in tissue PO2 when the leg was in the hanging position, which shows the importance of arterial perfusion pressure. After a compression bandage had been applied to the legs with cvi, the tissue oxygen pressure of the ulcers increased markedly, probably as a result of diminished blood stasis. These results can be explained either by a rarefaction of capillaries in the ulcer tissue or by fibrin diffusion barriers around the capillaries. The changes in the histograms after bandaging are thought to be caused by an improvement in venous circulation.