Lengua F, Herrera J J, Florsch C
Service de chirurgie générale et vasculaire de l'hôpital Neuenberg, Ingwiller.
J Mal Vasc. 1988;13(4):344-50.
83 CF phlebographies of the foot veins were carried out in varicose vein sufferers of both sexes in order to better understand the return venous circulation of the foot in detail, its abnormalities, and also to attempt to explain edema of the foot suffered by many varicose vein patients to varying degrees of severity after saphenous stripping. Films were obtained by direct needle puncture at different sites on the fore-foot, after a tourniquet was placed around the ankle. The route taken by the contrast medium injected was followed on a fluoroscop screen and photographed. Images obtained were classified under 4 headings: 1) slight, 2) moderate, 3) loaded and 4) overloaded opacification. In normal or slightly pathological cases (group 1 and 2), contrast medium was evacuated via a route ranging from level 1 (superficial) to level 3 (deep), this being the "usual evacuation circuit." In frankly pathological cases (groups 3 and 4), a "subsidiary evacuation circuit" may develop. It is also possible that after a degree of stagnation (by obstruction of the main veins of the foot) the contrast medium is very slowly evacuated by a number of small collateral veins. Edema of the foot as seen in some varicose vein patients as well as that which occurs post-operatively in the majority of patients undergoing varicose vein surgery is felt to be more often due to valve incompetence and to hypotonicity of the venous walls rather than to thrombosis of a deep vein of the foot.
为了更详细地了解足部的静脉回流循环及其异常情况，并且试图解释许多静脉曲张患者在大隐静脉剥脱术后不同程度地出现足部水肿的原因，对83名男女静脉曲张患者进行了足部静脉造影。在脚踝周围扎上止血带后，通过在前足不同部位直接针刺来获取影像。注入的造影剂所经过的路径在荧光屏上跟踪并拍照。所获得的图像分为4类：1）轻度，2）中度，3）充盈和4）过度充盈造影。在正常或轻度病变的病例（第1组和第2组）中，造影剂通过从第1级（浅表）到第3级（深部）的路径排空，这就是“通常的排空回路”。在明显病变的病例（第3组和第4组）中，可能会形成“辅助排空回路”。也有可能在出现一定程度的血液淤滞（由于足部主要静脉阻塞）后，造影剂通过一些小的侧支静脉非常缓慢地排空。一些静脉曲张患者出现的足部水肿以及大多数接受静脉曲张手术的患者术后出现的水肿，更多地被认为是由于瓣膜功能不全和静脉壁张力降低，而不是由于足部深静脉血栓形成。
