Priollet P
Service d'Hypertension Artérielle et Médecine Vasculaire, Hôpital Saint-Joseph, Paris.
Presse Med. 1994 Feb 10;23(5):229-35.
Manifestations of chronic venous insufficiency of the lower limbs are related to congenital or acquired stasis in the deep veins, to post-phlebitis occlusion of the deep veins or to stasis in the superficial veins. Functional impairment may be associated with varicose veins or not. Clinical signs include a heavy feeling in the legs, fatigue, and sometimes cramps or impatience in the evening. Sometimes there is a seasonal character to the complaints. The varicosities are localized in the territory of the medial saphenous vein, the lateral saphenous vein, or both and sometimes affect the pelvic region. Complications may occur including hemorrhage of the varicose veins, superficial phlebitis or orthostatic hypotension. An echo coupled Doppler helps determine the therapeutic indications and provides a mapping of the venous system for functional evaluations. Varicose veins result from minute dilatations of superficial vessels. There are exclusively of aesthetic importance. Chronic venous insufficiency can lead to permanent or intermittant oedema of the lower limbs without inflammation. When permanent, a large cold leg fits into a suggestive clinical picture non venous causes of oedema can be determined with an ultrasound exploration. Postphlebitic reactions are the most frequent causes of large cold lower limbs due to venous insufficiency. Poor cutaneous trophism of venous origin includes dermo-epidermitis, pigmented purpura dermitis, capillary ectasia, leukoderma, sclerodermiform hypodermitis and leg ulcers. Superficial venous ulcers are often quite large, painless and chronic. Their prevalence increases with age. Venous ulcers are more often secondary to phlebitis than to varicose veins. The socio-economic impact is great.
下肢慢性静脉功能不全的表现与深静脉先天性或后天性淤滞、深静脉血栓形成后阻塞或浅静脉淤滞有关。功能障碍可能与静脉曲张有关，也可能无关。临床症状包括腿部沉重感、疲劳，有时晚上会出现抽筋或烦躁不安。有时症状具有季节性。静脉曲张局限于大隐静脉、小隐静脉区域或两者皆有，有时会影响盆腔区域。可能会出现并发症，包括静脉曲张出血、浅静脉炎或体位性低血压。超声多普勒有助于确定治疗指征，并为功能评估提供静脉系统的图谱。静脉曲张是由浅表血管的微小扩张引起的。它们仅具有美学意义。慢性静脉功能不全可导致下肢永久性或间歇性水肿，且无炎症。当水肿为永久性时，下肢冰冷肿大符合典型的临床症状，可通过超声检查确定水肿的非静脉原因。血栓形成后反应是下肢静脉功能不全导致下肢冰冷肿大最常见的原因。静脉源性皮肤营养障碍包括皮肤真皮层炎、色素性紫癜性皮炎、毛细血管扩张、白斑、硬皮病样皮下炎和腿部溃疡。浅表静脉溃疡通常较大，无痛且呈慢性。其患病率随年龄增长而增加。静脉溃疡更多继发于静脉炎而非静脉曲张。其社会经济影响很大。
