Iafrati M, O'Donnell T F
Division of Vascular Surgery, New England Medical Center, Boston, MA 02111, USA.
J Mal Vasc. 1997 Jul;22(3):193-7.
All patients with significant venous stasis disease should undergo noninvasive evaluation to determine the magnitude, precise location, and etiology of the problem (i.e. obstruction and/or reflux). Patients who fail aggressive medical therapy (compression and skin care) and who have significant symptoms should be considered candidates for surgical correction. The majority of patients screened will have a significant component of superficial venous insufficiency with or without the presence of incompetent perforating veins. In this case we address the superficial and perforating venous systems prior to consideration of deep venous reconstruction. When correction of superficial venous incompetence fails to improve the patient's symptoms, they are then considered for deep venous reconstruction. Patients with primary venous insufficiency are typically good candidates for direct valvuloplasty performed using the open or angioscopic techniques, while patients with damaged (post thrombotic) or absent valves are best managed by vein valve transplantation or segmental transposition. Results for both valvuloplasty and vein valve transplantation demonstrate good intermediate term valvular patency and ulcer healing. It appears that when used as part of a complete treatment protocol addressing superficial, deep, and perforating venous systems, as well as attention to skin care and appropriate compressive therapy that surgical reconstruction for deep venous reflux affords significant benefit to our patients.
所有患有严重静脉淤滞疾病的患者均应接受无创评估，以确定问题的严重程度、精确位置和病因（即梗阻和/或反流）。积极药物治疗（压迫治疗和皮肤护理）无效且症状严重的患者应被视为手术矫正的候选对象。大多数接受筛查的患者都存在明显的浅静脉功能不全，伴或不伴有功能不全的穿通静脉。在这种情况下，我们在考虑深静脉重建之前先处理浅静脉和穿通静脉系统。当浅静脉功能不全的矫正未能改善患者症状时，再考虑深静脉重建。原发性静脉功能不全的患者通常是采用开放或血管内镜技术进行直接瓣膜成形术的良好候选对象，而瓣膜受损（血栓形成后）或缺失的患者最好通过静脉瓣膜移植或节段转位来治疗。瓣膜成形术和静脉瓣膜移植的结果均显示中期瓣膜通畅情况良好且溃疡愈合。似乎当作为完整治疗方案的一部分，涵盖浅静脉、深静脉和穿通静脉系统，并注重皮肤护理和适当的压迫治疗时，深静脉反流的手术重建能为我们的患者带来显著益处。
