Tibbs D J
Int Angiol. 1986 Oct-Dec;5(4):289-95.
New methods of investigation have given a fresh understanding of varicose veins. Aspects of this are described based on findings in patients investigated by Doppler flowmetry, functional phlebography and photoplethysmography. All observations refer to the upright position where various forms of failure in pumping blood upwards against gravity may arise. Simple varicose veins conduct flow from above a pumping mechanism to the low pressure area beneath it. Thus, saphenous incompetence allows downflow from the groin to below the musculovenous pumps of the calf and the foot. It is this reversed flow that creates tortuosity in the branch veins and sacculation beneath leaking saphenous valves. Perforator incompetence is often incidental and a concealed saphenous incompetence, without varicosites, is easily overlooked. Functional phlebography has shown that many patients with varicose veins also have inadequate deep vein valves so that the pumping mechanisms are soon overwhelmed and this may explain why some develop ulceration and others do not. Complex patterns of flow in superficial veins have been demonstrated, for example: strong collateral upflow past deformed deep veins whilst other veins allow spillage downwards: crossover incompetence with flow to the opposite limb and down its incompetent saphenous vein. The special investigations can accurately predict the outcome of surgery and are an important addition to successful management.
新的研究方法使人们对静脉曲张有了新的认识。本文基于对采用多普勒血流测定法、功能性静脉造影术和光电容积描记法进行检查的患者的研究结果，对静脉曲张的各个方面进行了描述。所有观察结果均针对直立位，此时可能会出现各种形式的血液向上对抗重力泵血失败的情况。单纯性静脉曲张使血液从高于泵血机制的部位流向其下方的低压区域。因此，大隐静脉功能不全可使血液从腹股沟向下流至小腿和足部的肌静脉泵下方。正是这种逆流导致分支静脉迂曲以及大隐静脉瓣膜渗漏下方出现囊状扩张。交通静脉功能不全往往是偶然发生的，而无静脉曲张的隐匿性大隐静脉功能不全很容易被忽视。功能性静脉造影显示，许多静脉曲张患者同时存在深静脉瓣膜功能不全，因此泵血机制很快就会不堪重负，这或许可以解释为什么有些患者会发生溃疡而有些患者则不会。已证实浅静脉存在复杂的血流模式，例如：强大的侧支血流向上经过变形的深静脉，而其他静脉则允许血液向下溢出；交叉性功能不全，血液流向对侧肢体并沿其功能不全的大隐静脉向下流动。这些特殊检查能够准确预测手术结果，是成功治疗的重要补充。
