Možný vliv hemodynamických faktorů na vznik recidivujícího refluxu u primárních varixů

English version

Vyšlo v časopise: Rozhl. Chir., 2011, roč. 90, č. 9, s. 527-532.
Kategorie: Monotematický speciál - Původní práce

Souhrn

Autor předkládá definici refluxu jako retrográdního toku v insuficientní žíle mezi póly ambulatorního tlakového gradientu způsobujícího zvýšení ambulatorního venózního tlaku. Recidivující reflux se též vyskytuje po správně provedené krosektomii se strippingem. Růst nových cév (neoangiogeneze) nebo dilatace stávajících venózních kanálů (vaskulární remodelace) se v těchto případech pokládal za hlavní příčinu recidiv. Pokusy zastavit rozvoj recidivujícího refluxu v třísle vložením mechanických bariér přes ligaturu safenofemorálního spojení byly neúspěšné.

Synergistický účinek dvou hemodynamických faktorů – rozdílu tlaku mezi femorální žílou a zbytkem safény ve stehně na jedné straně a tendence k obnovení centrifugálního toku na straně druhé – mohou hrát klíčovou roli při vzniku recidivujícího refluxu. Tlakový gradient je zjevným spouštěcím mechanismem. Obnovení centrifugálního toku by mohlo být předprogramovaným fenoménem, který zlepšuje omezené cévní zásobení při tepenných uzávěrech, ale způsobuje recidivující reflux v insuficientních povrchových žilách. Tímto způsobem lze vysvětlit, proč k recidivě refluxu dochází po kterémkoli terapetickém zásahu.

Klíčová slova:
venózní reflux – recidiva refluxu – tlakový gradient – obnovení centrifugálního toku

Zdroje

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