Matsuda H, Ota T, Okada M
Department of Surgery, Division II, Kobe University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1994 Jul;95(7):466-72.
To determine the appropriate treatment for patients with varix cruris, we performed three different methods of phlebography including direct phlebography, and compared their findings by each phlebography. Conventional ascending phlebography was taken routinely and initially in all limbs (n = 120). "Direct phlebography" developed by us was then indicated, when the visualization of the deep vein system was unclear by conventional ascending phlebography. This method was useful for the clear opacification of the deep vein system, and also was able to visualize the deep femoral vein clearly. After the precise diagnosis of varix cruris, descending phlebography under the Valsalva maneuver at supine position was carried out for the evaluation of the deep vein insufficiency. According to these phlebographic findings, conventional stripping with or without sub- or suprafascial ligation of communicating vein was indicated to saphenous typed varix cruris. The valvuloplasty to the highest valve in superficial femoral vein was carefully added in eight limbs which showed the significant reflux by added in eight limbs which showed the significant reflux by the descending phlebography. This valvuloplasty was remarkably contributed to the immediate healing of the stasis ulcer without recurrence. And compression sclerotherapy was selected to some patients with branch typed varix cruris.
为确定下肢静脉曲张患者的合适治疗方法，我们进行了三种不同的静脉造影方法，包括直接静脉造影，并比较了每种静脉造影的结果。所有肢体（n = 120）均常规且首先进行传统上行静脉造影。当传统上行静脉造影显示深静脉系统显影不清时，我们采用自行研发的“直接静脉造影”。该方法有助于深静脉系统清晰显影，还能清晰显示股深静脉。在明确诊断下肢静脉曲张后，为评估深静脉功能不全，在仰卧位瓦尔萨尔瓦动作下进行下行静脉造影。根据这些静脉造影结果，对于隐静脉型下肢静脉曲张，采用传统的大隐静脉剥脱术，可选择性地进行交通静脉筋膜下或筋膜上结扎。对于下行静脉造影显示有明显反流的8条肢体，仔细对股浅静脉最高瓣膜进行瓣膜成形术。这种瓣膜成形术对淤滞性溃疡的即刻愈合且无复发起到了显著作用。对于一些分支型下肢静脉曲张患者，选择了压迫硬化疗法。
