Priollet P
Service de médecine vasculaire et d'hypertension artérielle, hôpital Saint-Joseph, Paris.
Rev Prat. 1994 Mar 15;44(6):739-44.
Chronic venous insufficiency of the lower limbs has varied expressions: purely functional disorders, varicose veins, varicosities, oedema and trophic cutaneous disorders. For a given individual, these aspects are not necessarily increasing stages of severity of the same disease. On the other hand, many associations are possible; they are determined by the mechanism and the degree of chronic venous insufficiency, as well as by the clinical situation in which they develop. Work-up is based on careful clinical examination. Doppler examination and echography are useful for varices if radical treatment is considered. Ultrasound examination is required in case of cutaneous ulcer in order not to mistake a varicose ulcer for a trophic disorder due to incontinence of deep venous trunks, most often of thrombotic origin. Varicose veins can become complicated. Varicose haemorrhage requires immediate treatment by compression. Superficial phlebitis needs doppler examination and echography because it can be associated to deep venous thrombosis. With regard to varices and chronic venous insufficiency, treatment varies according to the concerns of the patients. Elastic compression stockings are useful whatever the clinical expression of the disease. "Phlebotropic" drugs can be used whenever venous insufficiency is associated with functional symptoms. The use of radical treatment, whether sclerosing injections or surgery, depends on anatomic lesions, the degree of venous incontinence and the severity of symptoms, but also on the desires of the patients, fully informed as to the advantages and the limitations of each technique. Personalized treatment is thus possible.
单纯的功能障碍、静脉曲张、静脉瘤、水肿和皮肤营养性障碍。对于某一个体而言，这些表现不一定是同一种疾病严重程度的递增阶段。另一方面，多种情况可能同时存在；它们由慢性静脉功能不全的机制和程度以及其发生时的临床状况决定。检查基于细致的临床检查。如果考虑进行根治性治疗，多普勒检查和超声检查对静脉曲张有用。出现皮肤溃疡时需要进行超声检查，以免将静脉曲张性溃疡误诊为因深静脉主干（最常见为血栓形成所致）功能不全引起的营养性障碍。静脉曲张可能会出现并发症。静脉曲张出血需要立即通过压迫进行治疗。浅表性静脉炎需要进行多普勒检查和超声检查，因为它可能与深静脉血栓形成有关。对于静脉曲张和慢性静脉功能不全，治疗会根据患者的情况而有所不同。无论疾病的临床表现如何，弹力压迫袜都很有用。只要静脉功能不全伴有功能性症状，就可以使用“促静脉回流”药物。根治性治疗的使用，无论是硬化剂注射还是手术，取决于解剖学病变、静脉功能不全的程度和症状的严重程度，同时也取决于患者的意愿，患者需充分了解每种技术的优缺点。因此可以进行个性化治疗。
