Labropoulos N, Giannoukas A D, Nicolaides A N, Veller M, Leon M, Volteas N
Academic Vascular Surgery Unit, St. Mary's Hospital Medical School, London, England.
Arch Surg. 1996 Apr;131(4):403-6. doi: 10.1001/archsurg.1996.01430160061011.
To determine the lower-limb venous hemodynamics in patients with varying grades of chronic venous insufficiency (CVI), not due to deep vein thrombosis, when matched for age and duration of disease.
Case-control study.
Normal volunteers and patients with different grades of CVI referred to the vascular unit of a university hospital.
Fifty-one legs (40 patients) with CVI, but without a history of deep vein thrombosis, and 24 normal legs (20 volunteer subjects). These selected legs were grouped according to the severity of CVI (classes 0 - through 3) so that each class was matched for age (all study participants <60 years) and duration of signs and symptoms (<10 years).
Air plethysmography and color flow duplex imaging.
Venous volume, venous filling index, and outflow, ejection, and residual volume fractions were assessed in all limbs with air plethysmography. The presence of reflux was confirmed by the results of color flow duplex imaging.
Ten (42%) of 24 limbs in class 0 had no reflux. Twenty-five (57%) of the 44 limbs in classes 0 and 1 had superficial reflux alone, while all the limbs in class 1 had some degree of reflux in the superficial veins. The sites of reflux in these limbs were similar. The patterns of reflux in classes 2 and 3 were more complex. Eight (26%) of the 31 limbs had superficial reflux alone, whereas 10 (32%) had all three systems involved (superficial, deep, and perforating). The venous volume, venous filling index, and residual volume fraction worsened with progression of CVI. Significant statistical differences could, however, only be demonstrated between classes 0 and 1 vs classes 2 and 3. No changes could be found in the ejection and outflow fractions.
Patients (age <60 years) with CVI of less than 10 years' duration and with no history of deep vein thrombosis had venous hemodynamic changes that correlated well with the clinical severity of the disease. This was owing to the increased reflux, as the ejecting ability of the calf muscle pump remained intact, and the venous outflow was normal.
确定不同程度慢性静脉功能不全（CVI）患者（非因深静脉血栓形成所致）在年龄和病程匹配时的下肢静脉血流动力学情况。
病例对照研究。
大学医院血管科的正常志愿者和不同程度CVI患者。
51条腿（40例患者）患有CVI但无深静脉血栓形成病史，以及24条正常腿（20名志愿者）。这些选定的腿根据CVI严重程度（0至3级）分组，以便每组在年龄（所有研究参与者<60岁）和体征及症状持续时间（<10年）方面相匹配。
空气容积描记法和彩色血流双功成像。
用空气容积描记法评估所有肢体的静脉容量、静脉充盈指数以及流出、射血和残余容量分数。彩色血流双功成像结果证实有无反流。
0级的24条肢体中有10条（42%）无反流。0级和1级的44条肢体中有25条（57%）仅有浅静脉反流，而1级的所有肢体浅静脉均有一定程度反流。这些肢体的反流部位相似。2级和3级的反流模式更为复杂。31条肢体中有8条（26%）仅有浅静脉反流，而10条（32%）所有三个系统（浅静脉、深静脉和穿通静脉）均受累。静脉容量、静脉充盈指数和残余容量分数随CVI进展而恶化。然而，仅在0级和1级与2级和3级之间存在显著统计学差异。射血分数和流出分数未发现变化。
病程小于10年且无深静脉血栓形成病史的CVI患者（年龄<60岁）存在与疾病临床严重程度密切相关的静脉血流动力学变化。这是由于反流增加，因为小腿肌肉泵的射血能力保持完好，且静脉流出正常。
