Assuntos
Fibrinolíticos/uso terapêutico , Trombectomia/métodos , Terapia Trombolítica/métodos , Veia Cava Inferior/cirurgia , Trombose Venosa/tratamento farmacológico , Doença Aguda , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Humanos , Trombectomia/instrumentação , Filtros de Veia Cava , Veia Cava Inferior/patologia , Trombose Venosa/sangue , Trombose Venosa/patologia , Trombose Venosa/cirurgiaRESUMO
The blood horizontal reflux via insufficient perforating veins (PV) from the deep venous system into subcutaneous one is considered an important factor of formation of chronic venous insufficiency in varicose disease (VD) and its recurrences (VDR). The role of PV in a VD progressing and in a VDR postoperatively in 774 patients, operated on for primary VD and 243 - VDR, is discussed. While determining significance of the blood horizontal reflux and substantiation of necessity for the PV ligation there must be taken into account the data of the colour duplex scanning concerning their valve apparatus state and clinical estimation of the disease severity.
Assuntos
Extremidade Inferior/patologia , Veia Safena/cirurgia , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Insuficiência Venosa/cirurgia , Adolescente , Adulto , Feminino , Hemodinâmica , Humanos , Ligadura , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Recidiva , Veia Safena/patologia , Índice de Gravidade de Doença , Varizes/patologia , Insuficiência Venosa/patologiaRESUMO
Actual issues of surgical treatment of patients, suffering complications of varicose disease severe forms, are discussed. The causes of unsatisfactory results of treatment of patients, suffering varicothrombophlebitis, the main of which is the absence of common tactics of operative treatment and anticoagulant therapy, were analyzed. There were formatted the groups of patients, suffering severe forms of varicose disease of various localization of thrombotic process, a differentiated tactics of their surgical treatment was proposed.
Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Tromboflebite/cirurgia , Varizes/cirurgia , Trombose Venosa/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medicina de Precisão , Índice de Gravidade de Doença , Tromboflebite/complicações , Tromboflebite/diagnóstico , Tromboflebite/diagnóstico por imagem , Ultrassonografia , Varizes/complicações , Varizes/diagnóstico , Varizes/diagnóstico por imagem , Trombose Venosa/complicações , Trombose Venosa/diagnóstico , Trombose Venosa/diagnóstico por imagemRESUMO
Experience of treatment of 176 patients, suffering thrombotic complications of severe forms of the lower extremities varicose disease (VDLE), was analyzed. In 20 patients, suffering varicothrombophlebitis (VTHPH) in severe forms of VDLE, morphological and immunohistochemical changes in the venous wall and surrounding tissues were studied. There were examined 28 patients, in whom thrombotic complications of the VDLE have had occurred, using diagnostic complex "PLR genetics thrombophilia". Recurrent course of thrombotic complications and coexistence of VTHPH and thrombosis of deep veins have had constitute the main criterion of such patients selection. The groups of patients, suffering severe forms of VDLE, were delineated, depending on thrombotic process localization, differentiated tactics of their surgical treatment was proposed.
Assuntos
Perna (Membro)/cirurgia , Trombofilia/cirurgia , Varizes/cirurgia , Trombose Venosa/cirurgia , Adulto , Idoso , Fatores de Coagulação Sanguínea/genética , Fatores de Coagulação Sanguínea/metabolismo , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Células Endoteliais/ultraestrutura , Feminino , Veia Femoral/patologia , Veia Femoral/cirurgia , Expressão Gênica , Humanos , Imuno-Histoquímica , Integrina alfa2/sangue , Integrina alfa2/genética , Integrina beta3/sangue , Integrina beta3/genética , Perna (Membro)/irrigação sanguínea , Perna (Membro)/patologia , Masculino , Pessoa de Meia-Idade , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/patologia , Miócitos de Músculo Liso/ultraestrutura , Inibidor 1 de Ativador de Plasminogênio/genética , Inibidor 1 de Ativador de Plasminogênio/metabolismo , Veia Safena/patologia , Veia Safena/cirurgia , Trombofilia/sangue , Trombofilia/patologia , Varizes/sangue , Varizes/complicações , Varizes/patologia , Trombose Venosa/sangue , Trombose Venosa/etiologia , Trombose Venosa/patologiaRESUMO
Pathogenetically substantiated approach, using surgical, laser and echosclerosing methods, was applied for improvement of the treatment results in patients, suffering venous forms of the inborn vascular malformations of the lower extremities. The results of examination and treatment in 2006-2009 period were analyzed in 98 patients. The stem malformations with superficial venous system affection was diagnosed in 59 (60.2%) patients, the same with a deep venous system affection--in 27 (27.6%), the extrastem affections--in 7 (7.1%) and the combined malformations--in 5 (5.1%). There was differential tactics of the surgical treatment used together with combination of original surgical procedures, newest laser methods and sclerotherapy, which have permitted to achieve satisfactory late results in 73 (74.5%) patients. Poor results in 25 (25.5%) patients were caused by the pathological process spread and proliferative activity of malformation, what was confirmed by immunohistochemical and morphological investigations data.
Assuntos
Extremidade Inferior/irrigação sanguínea , Malformações Vasculares , Procedimentos Cirúrgicos Vasculares/métodos , Veias/anormalidades , Adolescente , Adulto , Criança , Endotélio Vascular/metabolismo , Endotélio Vascular/patologia , Procedimentos Endovasculares/métodos , Feminino , Humanos , Fotocoagulação a Laser/métodos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Masculino , Músculo Liso Vascular/diagnóstico por imagem , Músculo Liso Vascular/patologia , Músculo Liso Vascular/cirurgia , Antígeno Nuclear de Célula em Proliferação/biossíntese , Fluxo Sanguíneo Regional/fisiologia , Escleroterapia/métodos , Resultado do Tratamento , Ultrassonografia , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/biossíntese , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/patologia , Malformações Vasculares/cirurgia , Veias/diagnóstico por imagem , Veias/patologia , Veias/cirurgia , Adulto JovemRESUMO
Results of treatment of 19 patients, suffering vascular malformation of the head region, were analyzed. Application of a new highly informative diagnostic methods of surgical intervention differential methods have promoted significant clinical improvement.
Assuntos
Cabeça , Procedimentos de Cirurgia Plástica/métodos , Malformações Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Embolização Terapêutica , Feminino , Cabeça/anormalidades , Cabeça/irrigação sanguínea , Cabeça/cirurgia , Humanos , Masculino , Microcirurgia , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Resultado do Tratamento , Malformações Vasculares/diagnóstico , Malformações Vasculares/etiologiaRESUMO
Results of surgical treatment of 8 patients, suffering chylothorax, persisting during 1-14 months are presented. The desease have appeared also resistant to complex conservative treatment trial. This kind of treatment was conducted with simultaneous intensive preoperative preparation, surgical intervention consisted of open thoracotomy with thoracic duct suturing and ligature. The operative treatment had appeared primarily ultimately successful in 5 (62.5%) patients, and after postoperative pleurodesis conduction--in 3 (37.5%). One week of intensive conservative therapy trial with simultaneous preoperative preparation and subsequent shift to surgical intervention constitutes an optimal tactical principle in the persisting chylothorax treatment.
Assuntos
Quilotórax/cirurgia , Ducto Torácico/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Adulto , Quilotórax/diagnóstico , Quilotórax/etiologia , Quilotórax/terapia , Terapia Combinada , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
The studying results of anatomical variants of the leg large subcutaneous vein (LLSV) and its tributaries structure are adduced, the possible ways of the blood reflux spread are determined. The authors present anatomical classification of varicose disease of the LLSV basin, the epidemiology data of the disease forms incidence are adduced.
Assuntos
Veia Safena/ultraestrutura , Varizes/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Fluxo Sanguíneo Regional/fisiologia , Veia Safena/fisiologia , Ultrassonografia Doppler em Cores , Varizes/fisiopatologia , Varizes/cirurgiaRESUMO
Lymphoedema--is a chronic disease, characterized by the volume enhancement of some part of body, more often--of the limbs, as a consequence of tissues oedema, caused by the lymphatic system transport and resorptive function disorder. Modern approaches to lymphoedema treatment foresees combination of conservative and surgical ones, for example, microsurgical, taking into account the oedema character, stage of the disease, the previous treatment efficacy.
Assuntos
Extremidade Inferior/fisiopatologia , Linfedema/fisiopatologia , Linfedema/cirurgia , Microcirurgia/métodos , Algoritmos , Doença Crônica , Humanos , Estudos RetrospectivosRESUMO
Diagnosis and treatment of the inborn angiodysplasia constitutes the complex problem of vascular surgery. Of the multiple causes, conditioned by such the state of the issue, it is necessary to stress such as unsatisfactory knowledge of physician, the absence of strict diagnostic criterions, the attempts of the pathology elimination by specialists of various disciplines. The aim of the investigation was to determine the principal clinical and ultrasonographic criterions, permitting to reveal vascular malformation rapidly and objectively, to differentiate its type, the spreading, to characterize hemodynamical disorders.
Assuntos
Malformações Arteriovenosas/diagnóstico por imagem , Vasos Sanguíneos/diagnóstico por imagem , Hemodinâmica/fisiologia , Ultrassonografia Doppler em Cores , Adolescente , Adulto , Malformações Arteriovenosas/fisiopatologia , Circulação Sanguínea/fisiologia , Vasos Sanguíneos/anormalidades , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Results of clinical examination and ultrasonic investigation in 478 patients with varicosic disease (VD) of lower extremities are adduced. Basing on the data obtained the clinicoanatomic forms of VD were deliniated. The typical and nontypical forms diseases criterions of ultrasound diagnosis were determined. It was demonstrated that the choice of the surgical treatment tactics in patients with VD depends on its clinicoanatomic form, and the principal method of diagnosis is the color duplex scanning.
Assuntos
Retina/diagnóstico por imagem , Telangiectasia/diagnóstico por imagem , Varizes/classificação , Varizes/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , UltrassonografiaRESUMO
The data on examination and surgical treatment of 35 patients, suffering severe forms of varicose disease in stage of trophic disorders occurrence and with an acute thrombophlebitis are adduced. The concept of an active surgical help, including thromboembolic complications prophylaxis, depending on thrombophlebitis localization, correction of the venous hemodynamics disorders and the staged closure of trophic ulcer is substantiated. Introduction of the proposed tactics had permitted to achieve satisfactory outcomes, including the trophic ulcer healing and the trophic disorders regression in all the patients operated on.
Assuntos
Tromboembolia/prevenção & controle , Tromboflebite/diagnóstico , Tromboflebite/cirurgia , Varizes/diagnóstico , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares , Doença Aguda , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tromboflebite/complicações , Úlcera Varicosa/etiologia , Úlcera Varicosa/cirurgia , Varizes/complicaçõesRESUMO
Results of examination and surgical treatment of 77 patients with severe forms of chronic venous and lymphovenous insufficiency of lower extremities were analyzed. The compression syndrome concept and its role in pathogenesis of severe forms of chronic venous and lymphovenous insufficiency of lower extremities were determined. There was elaborated the tactics of complex treatment of patients, application of which had permitted to achieve the trophic ulcers healing in 98% operated patients, previously considered noncurable.
Assuntos
Extremidade Inferior/irrigação sanguínea , Úlcera por Pressão/fisiopatologia , Úlcera por Pressão/cirurgia , Insuficiência Venosa/fisiopatologia , Insuficiência Venosa/cirurgia , Doença Crônica , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Masculino , Úlcera por Pressão/etiologia , Índice de Gravidade de Doença , Síndrome , Insuficiência Venosa/complicaçõesRESUMO
The results of clinical examination and surgical treatment of 115 patients with syndrome of chronic lymphovenous insufficiency of the lower extremities were adduced. The pathogenetically substantiated differentiated approach to the treatment was elaborated, which includes the staged surgical treatment conduction, directed on correction of the venous hemodynamics and the lymph outflow disorders, and the staged surgical treatment of trophic ulcers using alloderma and free cutaneous transplants. The tactics proposed had permitted to achieve satisfactory result of treatment in late period in 81%.
Assuntos
Perna (Membro)/irrigação sanguínea , Perna (Membro)/cirurgia , Linfedema/cirurgia , Flebite/cirurgia , Adulto , Idoso , Doença Crônica , Feminino , Hemodinâmica/fisiologia , Humanos , Perna (Membro)/patologia , Linfedema/complicações , Linfedema/patologia , Masculino , Pessoa de Meia-Idade , Flebite/complicações , Flebite/patologia , Úlcera/etiologia , Úlcera/patologia , Úlcera/cirurgia , Insuficiência Venosa/patologia , Insuficiência Venosa/cirurgiaAssuntos
Mamoplastia , Mastectomia/efeitos adversos , Mastectomia/psicologia , Período Pós-Operatório , Adulto , Feminino , HumanosRESUMO
During 1993-1996 period of time 175 patients with the lower extremities varication and post-thrombophlebitis syndrome (PTHPHS) were investigated using colour duplex scanning. Definite changes in the veins structure and spectral characteristics of blood flow in them corresponded to every PTHPHS stage. In an acute stage the lumen of the vessel is full of friable thrombotic masses, the blood from is absent. In 2-3 weeks the first recanalization signs appears showing the thrombus consolidation and residual blood flow. The recanalization process completes with the deep veins cusps destruction and retrograde blood escape occurrence, as a rule. The diagnosis criteria of each stage, the permissible limits of venous reflux, the hemodynamics peculiarities in combined affection of the deep veins various segments are substantiated.
Assuntos
Perna (Membro)/irrigação sanguínea , Ultrassonografia Doppler em Cores , Veias/diagnóstico por imagem , Doença Aguda , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Flebítica/diagnóstico por imagem , Fluxo Sanguíneo Regional , Transdutores , Ultrassonografia Doppler em Cores/instrumentação , Ultrassonografia Doppler em Cores/métodos , Varizes/diagnóstico por imagemRESUMO
Examination and surgical treatment of 31 patient with primary (17 cases) and secondary (14) lymphedema of an extremity at a stage of fibredema was carried out. It was established that a degree of increase in the volume of an extremity rather often didn't correspond to a stage of fibredema, pathological changes in the lymphatic vessels were pronounced to a different degree. However, this do not exclude possibility of their effective use for placing lymphoangiovenous anastomosis.
Assuntos
Perna (Membro)/irrigação sanguínea , Sistema Linfático/cirurgia , Linfedema/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Feminino , Humanos , Linfedema/patologia , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Resultado do Tratamento , Veias/cirurgiaRESUMO
The experience with clinical observation and surgical treatment of 217 patients with primary lymphedema of the lower extremities at stage II, IIIA (stage of "dropsy") is summarized. The working classification and developed complex of the diagnostic methods used are presented. The indications for the operations of creation of the lymphoangiovenous, lymphonodulovenous anastomoses, and as well the use of combined operations are considered; their effectiveness in different types of lesions of the lymphatic vessels is assessed. The methods for prevention of the erysipelatous inflammation recurrence with the use of endolymphatic intranodular administration of antibiotics are suggested. A complex of the developed measures permitted to obtain a satisfactory result at the nearest postoperative period in 74% of the patients, at the period of from 4 to 7 years--in 57%.