lower extremity communicating vein valve insufficiency
Introduction
Brief introduction of venous valve insufficiency in lower limb communication Arteriosclerosis obliterans is a degenerative disease, which is the basic pathological process of the large and middle arteries, mainly the abnormal deposition of cells, fibrous stroma, lipids and tissue fragments, complex pathology in the process of proliferation of the intima or middle layer of the arteries. Changes, in peripheral vascular disease, arterial stenosis, occlusion or aneurysmal lesions, almost all caused by arteriosclerosis. Arteriosclerotic lesions are generally systemic disorders that occur in some large, medium-sized arteries, such as the lower aorta, the radial artery, the femoral artery, and the radial artery. The upper extremity arteries are rarely involved. The diseased artery is thickened, hardened, accompanied by atheromatous plaque and calcification, and may be followed by thrombosis, resulting in stenosis or occlusion of the arterial lumen, ischemic symptoms in the limb, chills, numbness, pain, intermittent Clinical manifestations such as ulceration or necrosis of the sacral and toe or foot, sometimes stenotic or occlusive lesions are segmental and multiplanar, occurring in the bifurcation of the artery and the posterior wall of the lumen, and the curved portion of the trunk of the artery More often, the distal side of the lesion often has a smooth outflow tract. basic knowledge The proportion of sickness: 0.007% Susceptible people: no specific population Mode of infection: non-infectious Complications: hemangioma thromboangiitis obliterans vascular reticuloma angiosarcoma vasoactive intestinal peptide cerebral thrombosis
Cause
Lower extremity traffic venous valve insufficiency etiology
(1) Causes of the disease
Under normal circumstances, the venous blood flow of the foot is flowing from the deep vein to the superficial vein, while the rest of the lower limb is from the superficial vein to the deep vein. The lower extremity venous hypertension and poor valve structure are the main causes of traffic venous valve regurgitation, although traffic There are a large number of veins, but often only 3 to 5 have valvular insufficiency. At this time, blood flow from the deep vein to the superficial vein, and blood regurgitation in the traffic vein is important for the nutritional changes of the lower extremity skin, about 2/3 In patients with ulcers, there is a venous valve insufficiency in the traffic vein.
(two) pathogenesis
When the valvular insufficiency of the superficial vein (large saphenous vein) is reversed, and the deep vein and the communicating vein function normally, the blood flowing backward in the superficial vein can flow into the deep vein through the normal function of the traffic vein. The deep veins expand and distort due to the increase of blood flow, which finally causes the valve insufficiency in the deep vein to form a deep venous reflux disease; when the deep vein reflux lesions are intensified, especially after involving the iliac vein or even the deep vein of the calf In turn, the traffic veins can be expanded and the valves can be destroyed, which also causes venous valve insufficiency in the traffic, and finally causes dystrophic lesions in the internal iliac crest.
Prevention
Lower extremity traffic venous valve insufficiency prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Lower extremity traffic venous valve insufficiency complications Complications hemangioma thromboangiitis vasculitis vascular reticuloma angiosarcoma vasoactive intestinal peptide cerebral thrombosis
Hemangioma, thromboangiitis obliterans, vascular reticuloma, angiosarcoma, vasoactive intestinal peptide, deep venous thrombosis of lower extremities, thrombophlebitis of extremities, vascular injury of extremities, acquired arteriovenous fistula, simple Lower extremity varicose veins, allergic vasculitis, acute arterial embolism, cerebral arteriovenous malformation, cerebral thrombosis.
Symptom
Lower extremity traffic venous valvular insufficiency symptoms Common symptoms Skin atrophy and pigmentation Lower extremity skin vegetative changes Subcutaneous tissue induration limbs cold and eczema intermittent claudication
Most of the traffic venous valve regurgitation is accompanied by deep limbs and superficial venous valve insufficiency. Patients may have corresponding manifestations of deep and superficial venous insufficiency, while the lower extremity skin nutritional changes such as skin atrophy, desquamation, pigmentation, Induration of skin and subcutaneous tissue, eczema and refractory ulcers are often severe.
Examine
Lower limb communication venous valve insufficiency examination
Lower extremity venography can be found in traffic venous valve insufficiency, but the accuracy is not high. At present, Doppler blood flow imaging is more used. It is the most accurate examination method for locating traffic venous valve insufficiency. Check 1 day before surgery. The patient takes the standing position. If the traffic venous reflux is found to be >0.3~0.5s, it can be diagnosed and marked with a marker.
Diagnosis
Diagnosis and diagnosis of venous valve insufficiency in lower extremity
diagnosis
According to the clinical manifestations are more difficult to diagnose, mainly based on Doppler blood flow imaging examination, lower extremity venography and other confirmed diagnosis.
Differential diagnosis
(1) Post-deep vein thrombosis syndrome: This disease and deep vein thrombosis syndrome have stagnation of venous blood flow in the lower extremities, and the symptoms and signs are very similar, especially in patients with a long history of deep vein thrombosis. The situation has been unclear, and the deep vein thrombosis has been re-opened, which is more confusing, but there are still many aspects that can be identified.
(B) lower extremity arteriovenous fistula: lower branch arteriovenous fistula also has superficial varicose veins, pigmentation, dermatitis and ulcers, it is also necessary to identify with this disease, if caused by trauma, there is a history of trauma, often with a knife wound, Bullet penetrating injury, sharp stab wound and other medical history, local sputum and persistent vascular tremor, persistent vascular murmur during auscultation; if congenital, it is found from childhood, the limb can grow thicker, the skin temperature is obvious Elevation can also tremble and tremor and hear vascular murmurs. Differential diagnosis is generally not difficult. If necessary, lower extremity angiography can further confirm the diagnosis.
(3) Lymphedema: Some obese patients suffer from deep venous insufficiency of the lower extremities, and superficial varices may not be obvious. These patients still need to be differentiated from lymphedema. Lymphatic edema is swollen in the lower extremities, but no pigmentation and ulcers occur, and the skin often increases. Thick, calf, ankle, swelling of the back of the foot is the most, and the swelling of the venous valve is mainly in the calf, the ankle, the back of the foot is rarely swollen, the venous blood stasis of the venous insufficiency is mainly in the calf is not obvious, lymphedema The glare should occur under the skin, the ankle, and other soft tissues on the back of the foot are less, so the tumor is obvious. If necessary, the venous angiography is performed. The patients with lymphedema have no venous reversal.
(4) Klippel-Trenaunay syndrome: This disease may have superficial varicose veins and limb swelling, so it is also necessary to distinguish with this disease. Kilppel-Trenaunay syndrome is a congenital vascular malformation, with superficial varices, limb growth, skin blood vessels A group of triads of tumor, often with increased skin temperature, lesions involving the calf, thigh, often involving the buttocks, ascending venography can show venous malformations, most of which are congenital atresia of the iliac vein or femoral vein, the differential diagnosis is not difficult.
(5) Simple saphenous vein regurgitation: According to the venous angiography, the simple saphenous vein membrane closure and deep venous valve insufficiency can be identified. The deep venous valve closure is often combined with the great saphenous vein regurgitation and deep and shallow. Intravenous penetrating valvular insufficiency, the two are extremely difficult to distinguish in clinical symptoms and signs, some deep venous valvular insufficiency due to the compensatory effect of the calf muscle pump, help the lower extremity venous return, no swelling of the lower extremities, through a large number of venography It was found that about 66% of patients diagnosed with simple saphenous varices in the past were accompanied by deep venous insufficiency, so we believe that the two can be the same disease, but at different stages of the disease, or the degree of disease is different.
