Možný vliv hemodynamických faktorů na vznik recidivujícího refluxu u primárních varixů
Published in:
Rozhl. Chir., 2011, roč. 90, č. 9, s. 527-532.
Category:
Monothematic special - Original
Overview
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
Sources
1. Allegra, C., Antignani, P. L., Carlizza, A. Recurrent varicose veins following surgical treatment: our experience with five years follow-up. Eur. J. Vasc. Endovasc. Surg., 2007; 33: 751–756.
2. Delis, K. T. Leg perforator vein incompetence: functional anatomy. Radiology, 2005; 235: 327–334.
3. Labropoulos, N., Touloupakis, E., Giannoukas, A. D., Leon, M., Katsamouris, A., Nicolaides, A. N. Recurrent varicose veins: investigation of the pattern and extent of reflux with color flow duplex scanning. Surgery, 1996; 119: 406–409.
4. Rutherford, E. E., Kianifard, B., Cook, S. J., Holdstock, J. M., Whiteley, M. S. Incompetent perforating veins are associated with recurrent varicose veins. Eur. J. Vasc. Endovasc. Surg., 2001; 21: 458–460.
5. Zukowski, A. J., Nicolaides, A. N., Szendro, G., Irvine, A., Lewis, R., Malouf, G. M., et al. Haemodynamic significance of incompetent calf perforating veins. Br. J. Surg., 1991; 78: 625–629.
6. Carandina, S., Mari, C., De Palma, M., Marcellino, M. G., Cisno, C., Legnaro, A., et al. Varicose vein stripping vs hemodynamic correction (CHIVA): a long term randomized trial. Eur. J. Vasc. Endovasc. Surg., 2008; 25: 230–237.
7. Franceschi, C. Ambulatory and hemodynamic treatment of venous insufficiency (CHIVA cure). French. J. Mal. Vasc., 1992; 17: 291–300.
8. Zamboni, P., Feo, C. V., Marcellino, M. G., Vasques, G., Mari, C. Haemodynamic correction of varicose veins (CHIVA): an effective treatment? Phlebology, 1996; 11: 98–111.
9. Labropoulos, N., Kang, S. S., Mansour, M. A., Giannoukas, A. D., Buckman, J., Baker, W. H. Primary superficial vein reflux with competent saphenous trunk. Eur. J. Vasc. Endovasc. Surg., 1999; 18: 201–206.
10. Pichot, O., Sessa, C., Bosson, J. L. Duplex imaging analysis of the long saphenous vein reflux: basis for strategy of endovenous obliteration treatment. Int. Angiol., 2002; 21: 333–336.
11. Labropoulos, N., Tassiopoulos, A. K., Bhatti, A. F., Leon, L. Development of reflux in the perforator veins in limbs with primary venous disease. J. Vasc. Surg., 2006; 43: 558–562.
12. Arnoldi, C. C. Venous pressure in the legs of healthy human subjects at rest and during muscular exercise in nearly erect position. Acta Chir. Scand., 1965; 130: 570–583.
13. Bjordal, R. J. Simultaneous pressure and flow recordings in varicose veins of the lower extremity. Acta Chir. Scand., 1970; 136: 309–317.
14. Arnoldi, C. C. Venous pressure in patients with valvular incompetence of the veins of the lower limb. Acta Chir. Scand., 1966; 132: 628–645.
15. Höjensgard, I. C., Stürup, H. Static and dynamic pressures in superficial and deep veins of the lower extremity in man. Acta Physiol. Scand., 1952; 27: 49–67.
16. Recek, C., Pojer, H. Ambulatory pressure gradient in the veins of the lower extremity. VASA, 2000; 29: 187–190.
17. Bjordal, R. I. Circulation patterns in incompetent perforating veins in the calf and the saphenous system in primary varicose veins. Acta Chir. Scand., 1972; 138: 251–261.
18. El Wajeh, Y., Giannoukas, A. D., Gulliford, C. J., Suvarna, S. K., Chan, P. Saphenofemoral venous channels associated with recurrent veins are not neovascular. Eur. J. Vasc. Endovasc. Surg., 2004; 28: 590–594.
19. Geier, B., Stücker, M., Hummel, T., Burger, P., Frings, N., Hartmann, M., et al. Residual stumps associated with inguinal varicose vein recurrence: a multicenter study. Eur. J. Vasc. Endovasc. Surg., 2008; 36: 207–210.
20. Jones, L., Braithwaite, B. D., Selwyn, D., Cooke, S., Earnshaw, J. J. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomised trial of stripping the long saphenous vein. Eur. J. Vasc. Endovasc. Surg., 1996; 12: 442–445.
21. Winterborn, R. J., Foy, C., Earnshaw, J. J. Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein. J. Vasc. Surg., 2004; 40: 634–639.
22. Dwerryhouse, S., Davies, B., Harradine, K., Earnshaw, J. J. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins. Five-year results of a randomized trial. J. Vasc. Surg., 1999; 29: 589–592.
23. Egan, B., Donnelly, M., Bresnihan, M., Tierney, S., Feeley, M. Neovascularization: an „innocent bystander” in recurrent varicose veins. J. Vasc. Surg., 2006; 44: 1279–1284.
24. Joshi, D., Sinclair, A., Tsui, J., Sarin, S. Incomplete removal of great saphenous vein is the most common cause for recurrent varicose veins. Angiology, 2011; 62: 198–201.
25. Sarin, S., Scurr, J. H., Coleridge Smith, P. D. Stripping of the long saphenous vein in the treatment of primary varicose veins. Br. J. Surg., 1994; 81: 1455–1458.
26. Frings, N., Nelle, A., Tran, V. T. P., Glowacki, P. Unavoidable recurrence and neoreflux after correctly performed ligation of the saphenofemoral junction: neovascularization? (German). Phlebologie, 2003; 32: 96–100.
27. Frings, N., Nelle, A., Tran, P., Fischer, R., Krug, W. Reduction of neoreflux after correctly performed ligation of the saphenofemoral junction. A randomized study. Eur. J. Vasc. Endovasc. Surg., 2004; 28: 246–252.
28. Fischer, R., Linde, N., Duff, C., Jeanneret, C., Chandler, J. G., Seeber, P. Late recurrent saphenofemoral junction reflux after ligation and stripping of the great saphenous vein. J. Vasc. Surg., 2001; 34: 236–240.
29. Glass, G. M. Prevention of sapheno-femoral and sapheno-popliteal recurrence of varicose veins by forming a partition to contain neovascularization. Phlebology, 1998: 13: 3–9.
30. Turton, E. P., Scott, D. J., Richards, S. P., Weston, M. J., Berridge, D. C., Kent, P. J., et al. Duplex-derived evidence of reflux after varicose vein surgery: neoreflux or neovascularisation? Eur. J. Vasc. Endovasc. Surg., 1999; 17: 230–233.
31. van Rij, A. M., Jones, G. T., Hill, G. B., Jiang, P. Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence. J. Vasc. Surg., 2004; 40: 296–302.
32. Nyamekye, I., Sheppard, N. A., Davies, B., Heather, B. P., Earnshaw, J. J. Clinicopathological evidence that neovascularisation is a cause of recurrent varicose veins. Eur. J. Vasc. Endovasc. Surg., 1998; 15: 412–415.
33. Heim, D., Negri, M., Schlegel, U., De Maeseneer, M. Resecting the great saphenous stump with endothelial inversion decreases neither neovascularization nor thigh varicosity recurrence. J. Vasc. Surg., 2008; 47: 1028–1032.
34. Winterborn, R. J., Foy, C., Heather, B. P., Earnshaw, J. J. Randomized trial of flush saphenofemoral ligation for primary great saphenous varicose veins. Eur. J. Vasc. Endovasc. Surg., 2008; 36: 477–484.
35. Sheppard, M. A procedure for the prevention of recurrent saphenofemoral incompetence. Aust. NZ J. Surg., 1978; 48: 322–326.
36. Gibbs, P. J., Foy, D. M., Darke, S. G. Reoperation for recurrent saphenofemoral incompetence: a prospective randomised trial using a reflected flap of pectineous fascia. Eur. J. Vasc. Endovasc. Surg., 1999; 18: 494–498.
37. De Maeseneer, M. G., Philipsen, T. E., Vandenbroeck, C. P., Lauwers, P. R., Hendriks, J. M., De Hert, S. G., et al. Closure of the cribriform fascia: an efficient anatomical barrier against postoperative neovascularization at the saphenofemoral junction? A prospective study. Eur. J. Vasc. Endovasc. Surg., 2007; 34: 361–366.
38. Earnshaw, J. J., Davies, B., Harradine, K., Heather, B. P. Preliminary results of PTFE patch saphenoplasty to prevent neovascularization leading to recurrent varicose veins. Phlebology, 1998; 13: 10–13.
39. Bhatti, T. S., Whitman, B., Harradine, K., Cooke, S. G., Heather, B. P., Earnshaw, J. J. Causes of re-recurrence after polytetrafluorethylene patch saphenoplasty for recurrent varicose veins. Br. J. Surg., 2000; 87: 1356–1360.
40. Winterborn, R. J., Earnshaw, J. J. Randomized trial of polytetrafluorethylene patch insertion for recurrent great saphenous varicose veins. Eur. J. Vasc. Endovasc. Surg., 2007; 34: 367–373.
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