[Blue phlebitis with exo- and endo-caval filters: 5 case reports]. / Phlébites bleues sur filtres exo et endo-caves: 5 observations.

5 cases of phlegmatia caerula dolens have been observed after the fixation of a cava blocking. You will find below the characteristics of the case reports: Mean age of patients: 69.2, from 55 to 83. Early phlegmatiae caeruleae dolens: 2 cases; late phlegmatiae: 3 cases (3 and 4 years after the cava ligature). Clinical context: advanced age; general state alteration 1 case; artery predisposition: 2 cases; heparin thrombopenia: 1 case. Responsible material: ombrelle de Mobin Uddin: 3 cases; Adams-De Weese's Clip: 2 cases. Current filters are probably less thrombogenous. Nevertheless, these case reports make us aware of the fact that in case of predisposition and/or in case of precary hemodynamic conditions, any factor likely to generate or worsen a venous stasis can originate (immediately or later) a significant thrombosis and, particularly in a few conditions, a phlegmatia caerulea dolens. Consequently, partial cava blocking indications must be seriously taken into consideration and saved for cases in which embolic risk is patent.

[From venous ligation to vena cava filter. Objectives and hazards of vena cava interruption]. / De la ligature veineuse au filtre cave. Evolution des idées. Objectifs et aléas des interruptions caves.

Starting from the use of venous ligatures (the first measure employed), methods for the prevention of pulmonary embolism have been perfected to arrive now at the endocaval insertion of permanent or temporary filters. Both in the materials used and the techniques employed, major progress has been made and incidents and accidents (thrombosis, migration, perforation of the venous wall) have become rarer. The efficacy of classical treatment methods (anticoagulants, early mobilisation, hemodilution, etc.), the preventive value of which has long been recognized, must also be taken into account when making the decision. Specific indications for vena cava interruption procedures can be defined, but their very efficacy and the ease of insertion of filters have led to indications (on a prophylactic or adjuvant basis) which are often--and other than in special situations--dubious insofar as the prevention of embolism does not always require interruption of the vena cava and that complete freeing of the iliac veins is generally not a priority objective.

[Painful manifestations of the sequelae of phlebitis]. / Les manifestations douloureuses des séquelles de phlébite.

Pain may be absent from the various manifestations making up a post-phlebitis syndrome but when it is present it varies considerably from one patient to another. Thus the very common feeling of heaviness, generally not painful, may be perceived as being painful by certain patients either because of the particular severity of the feeling or because of a low pain threshold in certain cases. Since no method for the objective measurement of pain exists, the assessment of this symptom and of its severity remains highly subjective, most often based upon statements by the patients. However, in practice a distinction can be drawn between the following: Pain related to venous stasis: a simple feeling of heaviness most often but which, in certain patients, may take on a painful connotation. Among such "stasis" pains, particular mention must be made of venous intermittent claudication, a progressive feeling of calf tension during walking which becomes increasingly painful and finally forces the sufferer to stop. This symptom is generally linked to the obstruction of a large collecting vein. Pain accompanying a leg ulcer usually results from secondary infection. Mention may be made of the role of inflammatory lesions developing around the trophic problem and which may encompass nerves, in particular the internal saphenous nerve. Although classical, causalgia type pain is certainly rarer. Demyelinisation of peripheral nerves has been suggested as being at its origin. Once again, the role of inflammatory processes linked to secondary infection appears to be notable. The treatment of pain in a post-phlebitis patient must take the greatest possible account of the pathophysiology of the post-phlebitis syndrome responsible: disinfection of a leg ulcer, treatment of venous stasis by elastic support, or by surgery or sclerosing injections. Sympathectomy has been suggested in causalgia type pain. In fact, this operation has scarcely any indications in post-phlebitis syndrome.

[Phlegmasia caerulea dolens . Acute venous stasis and ischemic phlebothrombosis]. / Les phlébites bleues. Stase veineuse aiguë et phlébothrombose ischémiante.

On the basis of the data of the literature and of 25 personal cases, the problem of phlegmasia caerulea is contemplated in its whole. Grégoire made an outstanding description of the condition in 1938; it was related to an arterial spasm, but later works showed the importance of the venous block and the secondary character of the arterial involvement. A severe form of venous thrombosis, phlegmasia caerulea dolens often occurs in elderly patients (11/25 in our series) or in persons in a poor general condition. The primary phenomenon is the occurrence, in various etiological circumstances, of an acute venous stasis giving rise to a number of phenomena, including extensive thrombosis and arterial involvement, which lead to irreversible lesions and to gangrene. Thus there is a first reversible phase of acute venous stasis with a still moderate arterial involvement, and a second phase of evolution with marketed ischemia, in which the tissular lesions can become irreversible. The necrosis results from the massive obliteration of the cutaneous venulae, not from the arterial failure. The old term of venous gangrene (Cruveilhier) points out to the mechanism and makes the practicioner aware of the extreme severity of any ischemic phlebitis, which can reach an irreversible stage within a few hours. The condition is therefore an emergency, and venous drainage must be re-established as quickly as possible in the limb, thus breaking the pathological cycle leading to irreversible lesions. In the simple venous stasis phase, a medical treatment may be attempted, but it must not be continued if it is not effective. Venous thrombectomy, a quick and safe procedure, therefore is the solution to choose either at once or after a short trial of medical treatment. Phlegmasia caerula certainly is the best indication for this procedure. If operated on time, the results are excellents: however, in very advanced cases with massive and total thrombosis of the venous system, amputation remains the only solution.

[Lumbar sympathectomy for arteritis. A reliable and (almost) seventy year-old technique]. / La sympathectomie lombaire pour artérite. Une fidèle et vaillante (presque) septuagénaire.

The old procedure of lumbar sympathectomy has long been the only chance of avoiding amputation for arteritic patients. Its field of application has shifted as reconstructive surgery and medical therapy made progress, and it is no longer the only solution and has more precise indications. Proper evaluation of its chances of success according to the individual situations allows establishing its potential and limitations. This simple procedure, entailing no risk for the future, deserves remaining among the available means for the treatment of arteritis, despite its age.

[Pelvic venous stasis. Gynecologic impact. Is it possible to individualize gynecologic phlebology?]. / Stase veineuse pelvienne. Incidences gynécologiques. Peut-on individualiser une phlébologie gynécologique?

Pelvic phlebography, principally phlebography via endo-uterine access, can reveal states of chronic venous stasis in gynecological disorders. The existence of such stasis is reflected by the presence of varicoceles and of utero-vaginal and pampiniform plexuses. In some cases, dilatation of the ovarian vein raises the question of primary valvular insufficiency of these veins. The following were studied here on the basis of phlebographic data: the problem of pelvic pain and of Masters and Allen syndrome; pelvic stasis in the sequelae of phlebitis and of pelvic phlebitis; the problem of primary venous insufficiency (?); and the role of such stasis in various gynecological disorders. The pathogenic role of such stasis, either as the chief factor or as an accompanying or favouring factor, should be taken into consideration when determining the management.

[Aneurysm of the popliteal vein]. / Les anévrysmes de la veine poplitée.

Aneurysms of the popliteal vein are rare. They often seem to be favored by parietal dysplasia, but this is not a consistent finding. From a clinical viewpoint, the lesion is often asymptomatic. It may be detected fortuitously through the occurrence of a popliteal mass. In more severe cases, pulmonary emboli originating at the aneurysmal site will occur. As a rule, diagnosis is based on results from investigations such as phlebography and, more recently, echography which is bound to have a more important role in this field. Management must take the patient's history and background into account, depending upon which treatment will consist of either mere surveillance of asymptomatic patients, or resection possibly followed by restoration of venous circulation--placement of a caval block being restricted to very particular cases.

[Distal hyperirrigation syndrome. Clinical and physiopathological aspects]. / Le syndrome d'hyperirrigation distale. Clinique et physiopathologie.

In this retrospective study, distal hyperirrigation syndrome was identified by "irrigraphy", a functional exploration method used to define an irrigation index at various levels of the lower limbs as determined by pulse wave amplitude, heart rare and segmental resistances. In 47 lower limbs studied, there were 26 unequivocal, 14 relative and 7 "masked" hyperirrigations. The main etiology was diabetes (24 limbs), but the syndrome was also noted in cases of peripheral neuropathy and chronic venous insufficiency. There was no basic difference between unequivocal and relative hyperirrigations. Some hyperirrigation states were not apparent in irrigraphy because of arterial lesions on upstream axes. The syndrome was also observed in approximately the same number of cases in insulin-dependent and noninsulin-dependent diabetes. The clinical disorders observed were especially peripheral trophic ones, notably perforating ulcers of the foot or various ulcers. Changes in the irrigraphic profile were followed regularly in 20 limbs. The rise in distal irrigation indices was due to a drop in peripheral resistances related to an abnormal opening up of arteriovenous anastomoses. A state of spontaneous sympathectomy was thus constituted, particularly in diabetic patients. The process was similar in syndromes of neurologic origin and in venous stasis. The mechanism was local, with venous hypertension causing the opening up of arteriovenous shunts. However, microangiopathic lesions must also be taken into account, since they can cause or favor arteriovenous shunting. The opening up of arteriovenous anastomoses is in effect the element common to all syndromes of distal hyperirrigation of various origins.(ABSTRACT TRUNCATED AT 250 WORDS)

[Detection of acute venous thromboses using plethysmography. Possibilities and limitations]. / Détection des thromboses veineuses aiguës par la pléthysmographie. Possibilités et limites.

The combined use of careful clinical examination and venous occlusion plethysmography has good diagnostic reliability. The clinical examination provides an estimated percentage "clinical probability"; in the event of negativity, complementary plethysmography enables confirmation of a negative clinical diagnosis; positive plethysmography confirms a probable clinical diagnosis or establishes the probability of thrombosis in patients with poor clinical signs. Thus false negative or false positive cases may be easily eliminated. In the remaining dubious cases complementary investigations are necessary.