Mellière D, Almou M, Lellouche D, Becquemin J P, Hoehne M
J Mal Vasc. 1986;11(1):19-22.
Surgical treatment of varicose veins occasionally can be followed by severe limb ischemia either after surgery or sclerotherapy. We report here two cases with the clinical features and the therapeutic strategy. The first case concerned a woman operated by venous stripping. A post-operative acute ischemia occurred and was treated by femoro-femoral bypass and lumbar sympathectomy. However this procedure did not avoid persistent chronic ischemia, sciatica paralysis and equinus ankle blockage. A secondary arterial procedure associated with intensive physiotherapy and ankle arthrodesis led to a poor functional result, partly because of an irreversible algodystrophia. The second case concerned a woman treated by sclerotherapy. An injection of the drug in the retro-malleolar area was immediately followed by an acute foot ischemia. Heparin, xylocaine and sodium nitroprusside perfusion avoided a foot amputation, however osteoporosis and algodystrophia occurred. A sympathectomy was necessary two years later. These dramatic complications although unusual, may occur even with experienced physicians. Therefore a great attention is always necessary during these simple procedures. In case of acute ischemia, early diagnosis and aggressive treatment are necessary, but prevention remains more secure.
静脉曲张的手术治疗偶尔会在手术后或硬化治疗后出现严重的肢体缺血。我们在此报告两例具有临床特征和治疗策略的病例。第一例涉及一名接受静脉剥脱术的女性。术后发生急性缺血，通过股-股旁路移植术和腰交感神经切除术进行治疗。然而，该手术未能避免持续的慢性缺血、坐骨神经麻痹和马蹄足畸形。与强化物理治疗和踝关节融合术相关的二次动脉手术导致功能结果不佳，部分原因是不可逆的营养障碍。第二例涉及一名接受硬化治疗的女性。在内踝后区域注射药物后立即出现急性足部缺血。肝素、利多卡因和硝普钠灌注避免了足部截肢，但发生了骨质疏松和营养障碍。两年后需要进行交感神经切除术。这些严重的并发症虽然不常见，但即使是经验丰富的医生也可能发生。因此，在这些简单的手术过程中始终需要高度关注。一旦发生急性缺血，早期诊断和积极治疗是必要的，但预防仍然更为可靠。
