Suzuki Minoru, Unno Naoki, Yamamoto Naoto, Nishiyama Motohiro, Sagara Daisuke, Tanaka Hiroki, Mano Yuuki, Konno Hiroyuki
Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
J Vasc Surg. 2009 Nov;50(5):1085-91. doi: 10.1016/j.jvs.2009.06.003. Epub 2009 Jul 26.
Venodynamics and lymphodynamics may interact as an inseparable and mutually dependent dual outflow system. This study investigated the effect of surgical treatment on lower limb lymph flow in patients with varicose veins.
Thirty-nine patients with varicose veins in the lower limb (28 patients with unilateral limb, 11 patients with bilateral limb), who demonstrated great saphenous vein reflux, were investigated with air-plethysmography and indocyanine green (ICG) fluorescence lymphography before surgical treatment and 6 months later. Fifteen healthy volunteers participated in this study as a control. With air-plethysmography, venous volume (VV) and venous filling time were measured. Venous filling index (VFI) was calculated. For ICG lymphography, 0.3 mL of ICG (0.5%) was subcutaneously injected at the dorsum of the foot. After the injection, fluorescent image of ICG dye was traced on real-time video images using a near-infrared camera system. The interval until the dye reached the knee was measured (transit time [TT]) in a standing position, which was previously demonstrated to correlate with the interval measured using dynamic isotope lymphoscintigraphy.
In CEAP clinical stage venous disease, TT in patients with C4 approximately 6 and C2 approximately 3 was significantly longer than that in the control group (587 +/- 97 seconds, 484 +/- 82 seconds, 252 +/- 29 seconds, respectively, mean +/- SD, P < .01). Among all limbs with varicose veins, there were correlations between TT and VV (Pearson r = 0.31, P < .01), between TT and VFI (Pearson r = 0.48, P < .01). All patients underwent great saphenous vein stripping. Six months later, the venous clinical severity score significantly improved with significant reductions in both VV and VFI values. TT 6 months postoperatively was also significantly shorter than that before surgical treatment (501 +/- 67 seconds, 340 +/- 38 seconds, respectively, mean +/- SD, P < .01).
Varicose veins could affect lymphatic function and delay lymphatic flow in the lower limbs. Derangement of lymph flow may correlate with the severity of clinical venous disease and/or the magnitude of venous reflux, which could be reversible with surgical treatment of venous incompetence.
静脉动力学和淋巴动力学可能作为一个不可分割且相互依存的双流出系统相互作用。本研究调查了手术治疗对静脉曲张患者下肢淋巴流动的影响。
39例下肢静脉曲张患者（28例单侧肢体，11例双侧肢体），均存在大隐静脉反流，在手术治疗前及术后6个月采用空气体积描记法和吲哚菁绿（ICG）荧光淋巴造影进行研究。15名健康志愿者参与本研究作为对照。采用空气体积描记法测量静脉容量（VV）和静脉充盈时间。计算静脉充盈指数（VFI）。对于ICG淋巴造影，在足背皮下注射0.3 mL ICG（0.5%）。注射后，使用近红外摄像系统在实时视频图像上追踪ICG染料的荧光图像。测量染料到达膝部的时间间隔（传输时间[TT]），站立位测量，此前已证明该时间间隔与动态同位素淋巴闪烁造影测量的时间间隔相关。
在CEAP临床分期的静脉疾病中，C4期（约6级）和C2期（约3级）患者的TT显著长于对照组（分别为587±97秒、484±82秒、252±29秒，均值±标准差，P<.01）。在所有有静脉曲张的肢体中，TT与VV之间存在相关性（Pearson r = 0.31，P<.01），TT与VFI之间存在相关性（Pearson r = 0.48，P<.01）。所有患者均接受了大隐静脉剥脱术。6个月后，静脉临床严重程度评分显著改善，VV和VFI值均显著降低。术后6个月的TT也显著短于手术治疗前（分别为501±67秒、340±38秒，均值±标准差，P<.01）。
静脉曲张可影响下肢淋巴功能并延迟淋巴流动。淋巴流动紊乱可能与临床静脉疾病的严重程度和/或静脉反流程度相关，静脉功能不全的手术治疗可使其逆转。
