Nash T
St. Vincent's Hospital, University of New South Wales, Sydney, Australia.
J Cardiovasc Surg (Torino). 1988 Nov-Dec;29(6):712-6.
Most patients with chronic venous ulceration or severe pre-ulcer damaged skin have incompetent popliteal valves and a high ambulant venous pressure (AVP). Competency can be restored by a vein valve transplant taken from the arm and placed in the popliteal fossa, with subjective and objective improvement. In this study 23 patients with post-phlebitic syndromes received 25 vein valve grafts as part of management. Seventeen patients had large recurrent ulcers after unsuccessful venous surgery: 6 patients had extensive pre-ulcer skin damage. Fifteen of 17 patients healed their ulcers, and all 6 patients with skin damage showed rapid improvement with relief of symptoms. Falls in the AVP, ranging from 10 to 40 mmHg occurred in 19 patients. All vein valve transplants were patent, after 18 months, but 5 grafted valves have evidence of venous reflux. These results suggest a functioning valve replacement in the popliteal fossa may lower the AVP sufficiently to heal intractable venous ulcers or severely damaged skin. Vein valve transplants function well long term, and the falls in the AVP are usually maintained. The popliteal fossa may be the ideal site since a component popliteal valve has been shown to limit adverse post-phlebitic changes.
大多数患有慢性静脉溃疡或严重溃疡前皮肤损伤的患者存在腘静脉瓣膜功能不全及较高的活动时静脉压（AVP）。取自手臂的静脉瓣膜移植至腘窝可恢复瓣膜功能，患者主观及客观状况均有改善。本研究中，23例静脉炎后综合征患者接受了25次静脉瓣膜移植作为治疗的一部分。17例患者在静脉手术失败后出现大面积复发性溃疡，6例患者有广泛的溃疡前皮肤损伤。17例患者中有15例溃疡愈合，所有6例皮肤损伤患者症状迅速改善且症状缓解。19例患者的AVP下降，幅度为10至40 mmHg。18个月后，所有静脉瓣膜移植均通畅，但5个移植瓣膜有静脉反流迹象。这些结果表明，在腘窝进行有效的瓣膜置换可能足以降低AVP，从而治愈难治性静脉溃疡或严重受损的皮肤。静脉瓣膜移植长期功能良好，AVP下降通常能维持。腘窝可能是理想部位，因为已证明腘静脉瓣膜的一个组成部分可限制静脉炎后的不良变化。
