RESUMEN
Chronic venous insufficiency is a pathologic condition of the skin and subcutaneous tissues in the lower extremity caused by stasis of the blood flow. Incompetency or failure of the venous valves results in reflux and ambulatory venous hypertension, which is more severe with deep than with superficial venous incompetency. Superficial chronic venous insufficiency (varicose veins) is effectively managed with ligation and stripping of incompetent perforator and superficial veins to restore normal venous physiology. Deep chronic venous insufficiency (postphlebitic leg) presents a widespread pathologic disorder that is refractory to surgical correction. Adjunctive surgical measures such as removal of incompetent perforators or superficial veins to lessen local stasis or skin grafting of ulcers are often indicated in selected cases. The underlying chronic venous insufficiency requires management with elastic compression, elevation of the legs, and exercise for best results.
Asunto(s)
Insuficiencia Venosa/cirugía , Vendajes , Enfermedad Crónica , Vestuario , Terapia Combinada , Terapia por Ejercicio , Humanos , Ligadura , Síndrome Posflebítico/etiología , Síndrome Posflebítico/cirugía , Síndrome Posflebítico/terapia , Recurrencia , Vena Safena/cirugía , Trasplante de Piel , Várices/etiología , Várices/cirugía , Insuficiencia Venosa/etiología , Insuficiencia Venosa/terapiaRESUMEN
Congenital cavernous hemangioma of the lower extremity is a form of congenital angioplastic dysplasia involving the venous trunks and capillaries. Although elastic support offers good symptomatic control, surgical removal of large, abnormal, superficial veins and ligation of incompetent perforators may be of definite additional benefit in carefully selected cases. Also, surgical excision of thrombosed veins, eroding cutaneous veins, and localized cavernous hemangiomas will lessen the chronic disability caused by this venous anomaly. But before any surgical treatment is undertaken, it must be determined that the deep venous system is adequate.
Asunto(s)
Hemangioma Cavernoso/cirugía , Pierna/irrigación sanguínea , Adolescente , Adulto , Niño , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Hemangioma Cavernoso/congénito , Hemangioma Cavernoso/patología , Humanos , Hipertrofia/patología , Pierna/patología , Masculino , Flebografía , Recurrencia , Reoperación , Vena Safena/patología , Várices/congénito , Várices/patología , Venas/cirugíaRESUMEN
Of 3,941 patients who underwent varicose vein surgery from 1968 through 1978, 163 had superficial thrombophlebitis, a common complication of varicose veins. Superficial thrombophlebitis was more frequently found in the older age groups. The incidence of occurrence (three women to one man) was identical to that of the overall group operated on for varicose veins. Twenty-two percent of the patients had thrombophlebitis that extended into the saphenous vein at or near the saphenofemoral juncture. Superficial thrombophlebitis was more frequently located in the varicosities below the knee instead of above the knee. The prolonged duration of superficial thrombophlebitis and the recurrent attacks suggest that thrombophlebitis can be chronic, recurrent, or subacute and may remain a threat as long as the varicosities are present. Review of these 163 patients, 161 of whom have been followed up from 1 to 12 years (average 5 years), who were consecutively treated by surgical excision of the thrombosed segments, with excision or stripping of the remaining varicosities, underscores the clinical impression that the surgical removal of the thrombosed vein segments and the associated varicosities shortens the convalescence and mitigates against later recurrence. This form of treatment was accomplished without death or significant morbidity, except for two patients who had clinical suspect nonfatal minor pulmonary emboli during the postoperative hospital period. Prophylactic anticoagulants were used in most patients. Surgical removal of the varicosities with excision of the thrombosed veins is currently our preferred treatment for superficial thrombophlebitis in otherwise healthy patients.
Asunto(s)
Tromboflebitis/cirugía , Várices/complicaciones , Adulto , Anciano , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Vena Safena , Tromboflebitis/diagnóstico , Tromboflebitis/etiología , Várices/cirugíaRESUMEN
Varicose veins are a common problem that still presents a major challenge to the physician and the patient. Complete surgical removal of the malfunctioning veins has proved to be the most effective management for significant varicosities, although several nonsurgical methods are available for mild cases or those not suitable for surgery.
Asunto(s)
Várices/terapia , Celulitis (Flemón)/etiología , Dermatitis/etiología , Hemorragia/etiología , Humanos , Úlcera de la Pierna/etiología , Trastornos de la Pigmentación/etiología , Tromboflebitis/etiología , Várices/complicaciones , Várices/diagnósticoRESUMEN
When surgical treatment of varicose veins is not indicated or is withheld because of associated problems of greater magnitude, other therapeutic measures may be considered. These include elastic support, elevation of the legs, exercise to strengthen the calf musculature, and sclerotherapy. Each of these measures, independently or in combination, provides considerable relief of signs and symptoms of the venous problems in many patients. In difficult venous stasis problems in which the optimal treatment remains in doubt, a therapeutic trial of elastic support is safe and often helpful in defining the role of chronic venous insufficiency in the patient's symptom complex.