[Congenital anomalies of the inferior vena cava: diagnosis and medical treatment].

Analyzed herein are the findings obtained following an examination and medical treatment of five 17-to-39-year-old male patients (average age 25.0+/-1.83 years) presenting with congenital abnormalities of the inferior vena cava. The diagnosis was made and the level of aplasia was determined based on the findings of a comprehensive instrumental examination (computed and magnetic resonance tomography of the abdominal cavity, duplex scanning of the veins of the lower extremities, of the pelvis and the retroperitoneal space, as well as on the data of pelvic phlebography, and retrograde cavography). In three of the five patients, the disease appeared to have for the first time manifested itself by a clinical picture of peripheral thrombosis (oedema of the crus and femur), and in the remaining two by an elevated body temperature and shivering, followed by oedema of the both lower limbs. Two patients were found to have aplasia of the infrarenal segment of the inferior vena cava, two subjects had aplasia of the infra-, renal and partially suprarenal portions of the vessel, and one patient suffered from aplasia of virtually the whole vena cava, excepting a small part of the suprahepatic portion, toward which converged the hepatic veins and the superior polar renal vein. With the purpose of early diagnosis of congenital abnormalities of the inferior vena cava, the protocol of examination of patients with venous diseases should include ultrasonographic mapping of the supra-, renal and infrarenal portions of the vena cava, and if agenesis is revealed, the use of computed or magnetic resonance tomography, retrograde cavography is strongly recommended. When the diagnosis of IVC aplasia is confirmed, primary medical treatment should consist in prescribing venotonic agents, elastic compression and in cases of deep veins thrombosis -anticoagulant therapy.

[The diagnosis and surgical treatment procedure in arteriovenous dysplasia]. / Diahnostyka i khirurhichna taktyka likuvannia arterio-venoznoï dysplaziï.

The operation volume pathogenetic substantiation in every period of surgical treatment was achieved due to broad application of roentgen-contrast phlebo- and arteriography in complex investigation of the regional blood flow disorders in patients with phleboarterial dysplasia (PAD). Artificial embolization application, in transcatheter and suboperational fashion, promoted the reduce of suboperational blood loss by 3-4 times. Positive result was achieved in 86% of patients due to the staged approach for the PAD surgical treatment.

Treatment of congenital venous avalvulosis using a surgically created autogenous vein valve.

A patient with venous valve hypoplasia resulting in chronic venous insufficiency is presented and a method of surgical correction by creation of an autogenous femoral vein valve described. A saphenous vein segment was opened posteriorly and inverted cephalad into the common femoral vein to construct a monocuspid vein valve. At 1 month after operation the patient experienced significant symptomatic improvement. The valve was patent and competent when assessed by Doppler venous examination but slight incompetence was shown by Valsalva's manoeuvre. This procedure appears to be a useful technique for the correction of deep vein reflux caused by venous valve aplasia and hypoplasia but requires further short- and long-term investigation.

[Idiopathic left-sided varicocele. An ontogenetic abnormality?]. / Die idiopathische linksseitige Varikozele. Eine ontogenetische Fehlentwicklung?

Phlebograms for sclerotherapy of varicoceles were performed in 659 patients. In 484 cases no valves of the left spermatic vein could be demonstrated. However, 172 patients showed sufficient valves or absent insertions of the spermatic veins at typical point with retrograde flow through collaterals (persistent intercardinal anastomoses). The value of nutcracker phenomena I and II is discussed. Ontogenetic disorders in the development of the secondary abdominal venous system are responsible for the occurrence of the idiopathic left-sided varicocele.

[Congenital absence of vein valves of the lower extremities].

Sixteen patients with congenital absence of venous valves in the deep veins of 18 lower limbs are reported. The disease limbs characterized by venous hypertension is frequently seen in teen-agers. Venographically, no valve is to be found in the deep venous system. Conservative treatment may be tried in those without pigmentation and ulcer formation in the goiter area. However, valvular reconstructive operation of the deep veins is the effective method of treatment.

Control of therapy with microcirculatory and phlebotropically active drugs in patients with congenital and acquired venous insufficiency.

During the treatment of two patients with Klippel-Trenaunay syndrome interesting observations of the efficacy and the side effects of DHE were made. This led to the decision to carry out a validity study in 12 patients suffering from chronic venous insufficiency (CVI). The patients were treated with 0.25 mg or 0.5 DHE intravenously, and after that with 7.5 mg orally for one week. Before and after treatment measurements of venous capacity, microcirculatory parameters and rheological parameters were performed. Following the i.v. injection of 0.25 to 0.5 mg DHE the venous capacity decreased significantly in a dose-dependent way. The flow of erythrocytes in capillaries measured under resting condition was significantly lower and peak flow of reactive hyperemia decreased. No relation was found between the dose of DHE administered and the particular side effects (stomach trouble, increase in diastolic blood pressure) in 2 of the 12 patients. After oral treatment patients showed signs of subjective improvement of their complaints. On the basis of the results, the validity of non-invasive angiological tests is discussed.

Congenital angiodysplasia of the superficial venous system of the lower extremities in children.

Congenital angiodysplasia of the superficial venous system (SVS) of the lower extremities was diagnosed in 24 children 3-15 years of age. Nine patients presented with painful swelling in the affected limb. Venectasia and spongy venous masses were the main morphologic changes in the current series. Selective ascending functional phlebography and superficial phlebography were used to assess the anatomic extension of the lesions and to evaluate the functional status of the involved extremity: 14 patients had only SVS angiodysplasia, in 10 patients additional pathologic features of the deep veins (DV) were found. Venous reflux was demonstrated in 16 patients and significant venous insufficiency was detected in five patients. The patients were classified into three groups according to the severity of the disease: mild (11 patients), moderate (8 patients), and severe (5 patients). The prognostic and the long-term outcome of surgical treatment can be predicted by the depth and the extension of the angiodysplastic lesions.

Congenital venous valvular aplasia of the lower extremities.

A 10-year-old girl had bilateral, symmetrical swelling of the lower extremities, which had been present since the age of 1 year. Noninvasive vascular laboratory measurements of the ambulatory venous pressure, venous recovery time, and maximum venous outflow revealed profound bilateral lower extremity venous valvular incompetence. Duplex imaging of the veins of the lower extremities demonstrated no evidence of thrombosis, and no venous valves could be imaged. On phlebography, the patient was found to have no venous valves in the superficial and deep systems of the leg. We conclude that congenital absence of the venous valves of the lower extremities is almost certainly underdiagnosed and that the vascular laboratory can accurately and easily differentiate between lymphedema and venous valvular imcompetence. Such differentiation may have therapeutic implications.

[Clinical aspects, diagnosis and treatment of ectasia of the deep veins of the lower extremities]. / Klinika, diagnostika i lechenie éktazii glubokikh ven nizhnikh konechnostei.

Ectasia of profound veins is a peculiar form of the venous insufficiency of lower extremities resulting in disturbed blood outflow. Ectasia may be congenital and acquired. In the latter case phlebectasia of profound veins may develop without phlebitis or as a result of it. The cardinal symptoms are bursting pains and edemas due to loads in the vertical posture. A reliable diagnosis of this disease can be made by means of angiography only. It is expedient to differentiate compensated and decompensated ectasia of profound veins. In the latter cases it is necessary to perform a resection of communicating veins in combination with fascioplasty and removal of subcutaneous veins. In compensated cases veinectomies might be sufficient but the patients should be given more strict recommendations.