Atherosclerosis obliterans is a degenerative disease, which is the basic pathological process of large and medium arteries. It is mainly characterized by abnormal deposition of cells, fibrous matrix, lipids, and tissue fragments, complex pathological changes occurring during the hyperplasia process in the intima or media of arteries. In peripheral vascular diseases, the narrowing, occlusive, or aneurysmal lesions of arteries are almost all caused by atherosclerosis. Atherosclerotic lesions are generally systemic diseases, commonly occurring in some large and medium-sized arteries, such as the lower segment of the abdominal aorta, iliac artery, femoral artery, and popliteal artery, while the upper extremity arteries are rarely involved. The affected arteries become thickened, hardened, accompanied by atheromatous plaques and calcification, and can lead to thrombosis, resulting in narrowing or occlusion of the artery lumen, causing ischemic symptoms in the limbs. The affected limb may show symptoms such as coldness, numbness, pain, intermittent claudication, and ulcers or necrosis of the toes or feet. Sometimes, the narrowing or occlusive lesions are segmental and multiplanar, commonly occurring at the bifurcation starting parts and posterior wall parts of the artery lumen, and the bending parts of the main artery trunk are also frequently involved. The distal part of the lesion often has a patent outflow tract.
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Incomplete Closure of the Superficial Venous Valves in Lower Limbs
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1. What Are the Causes of Incomplete Closure of the Superficial Venous Valves in Lower Limbs
2. What Complications Are Likely to Be Caused by Incomplete Closure of the Superficial Venous Valves in Lower Limbs
3. What Are the Typical Symptoms of Incomplete Closure of the Superficial Venous Valves in Lower Limbs
4. How to Prevent Incomplete Closure of the Superficial Venous Valves in Lower Limbs
5. What Laboratory Tests Are Required for Patients with Incomplete Closure of the Superficial Venous Valves in Lower Limbs
6. Diet Restrictions for Patients with Incomplete Closure of the Superficial Venous Valves in Lower Limbs
7.西医治疗下肢交通静脉瓣膜关闭不全的常规方法
7. The conventional method of Western medicine for the treatment of incomplete closure of the lower limb communicating venous valves. 1
What are the causes of the incomplete closure of the lower limb communicating venous valves?
1, Etiology
Under normal circumstances, the blood flow of the communicating veins on the dorsum of the foot flows from the deep veins to the superficial veins, while the rest of the lower limb is from the superficial veins to the deep veins. Hypertension of the lower limb veins and malformation of the valve structure are the main causes of incomplete closure of the communicating venous valves. Although there are many communicating veins, there are often only 3 to 5 veins with incomplete closure, at this time the blood flows from the deep veins to the superficial veins. The retrograde flow of the communicating venous blood has an important significance for the nutritional changes of the skin of the lower limbs. About 2/3 of ulcer patients have incomplete closure of the communicating venous valves.
2, Pathogenesis
When the valve function of the superficial veins (great saphenous vein) is incomplete and there is a reflux lesion, while the deep veins and communicating veins function normally, the blood flowing distally in the superficial veins can pass through the normally functioning communicating veins into the deep veins, causing the deep veins to dilate and twist due to the increase in blood flow volume, eventually leading to incomplete closure of the valves in the deep veins and causing a reflux lesion in the deep veins; when the reflux lesion in the deep veins becomes more severe and especially involves the popliteal veins even the deep veins of the lower legs, it can further cause the communicating veins to dilate and destroy the valves within them, resulting in incomplete function of the communicating venous valves as well, and finally leading to nutritional disorders of the skin at the medial malleolus.. 2
What complications can the incomplete closure of the lower limb communicating venous valves easily lead to?
Angioma, thromboangiitis obliterans, angioendothelioma, angiosarcoma, vascular active intestinal peptide tumor, congenital arteriovenous fistula, deep vein thrombosis of the lower limbs, thrombophlebitis of superficial veins in the limbs, vascular injury in the limbs, acquired arteriovenous fistula, varicose veins of the lower limbs, allergic angiitis, acute arterial embolism, arteriovenous malformation in the brain, cerebral thrombosis. 3
What are the typical symptoms of the incomplete closure of the lower limb communicating venous valves?
The majority of incomplete closures of the communicating venous valves are accompanied by incomplete closures of both deep and superficial venous valves in the lower limbs. Patients may have corresponding manifestations of incomplete function of the deep and superficial venous valves, as well as severe changes in the nutritional status of the skin of the lower limbs, such as skin atrophy, desquamation, hyperpigmentation, hardening of the skin and subcutaneous tissue, eczema, and refractory ulcers.. 4
How should the incomplete closure of the lower limb communicating venous valves be prevented?
Increase physical fitness and strengthen physical exercise. Commonly use cold water to wash the face and body, prevent colds, have work and rest, and live in a regular manner. Engage in outdoor activities in the morning or after work. Develop good living habits, quit smoking and limit alcohol. Smoking and drinking are extremely acidic acidic substances, and those who smoke and drink for a long time are prone to acidic constitution. Strengthen exercise: Participate in physical exercise regularly to enhance the body's defense ability.. 5
What laboratory tests are needed for the incomplete closure of the lower limb communicating venous valves?
The venography of lower limb veins can reveal incomplete closure of the communicating venous valves, but its accuracy is not high. Currently, Doppler blood flow imaging is more commonly used, which is the most accurate method for locating incomplete closure of the communicating venous valves. The examination is performed one day before surgery, with the patient in a standing position. If the retrograde flow of the communicating veins is greater than 0.3 to 0.5 seconds, it can be diagnosed and marked with a marker pen.. Dietary taboos for patients with tributary vein insufficiency in the lower limb
It should be avoided to eat too much cholesterol-rich food, such as cow (pig) brain, egg yolk, eel, liver, cuttlefish, etc. To supplement protein, low cholesterol foods such as pork (beef) lean meat, chicken (duck) meat, eggs, milk, etc. should be eaten. It should also be avoided to eat peanut oil and coconut oil, as they can all promote the formation of atherosclerosis. Those with high cholesterol should consume cholesterol daily
7. Conventional methods of Western medicine for the treatment of tributary vein insufficiency in the lower limb
I. Treatment
Surgical treatment should be performed for patients with tributary vein insufficiency in the lower limb with skin nutritional changes. Ulcer patients should wait for the ulcer to heal or the granulation tissue to be fresh before surgery.
1. Subfascial tributary vein ligation
Linton first invented the subfascial tributary vein ligation in 1938. Due to the use of a lower leg incision from the knee to the ankle, there were many incision complications after the operation, and it was soon improved. The common method now is to make several short incisions parallel to the skin皱纹, and ligate the tributary veins under the fascia. In 1976, Edwards invented a venous knife, which can be pushed down 2-4 cm along the medial margin of the tibia from the incision below the knee through the subfascia. In addition, punctate incisions can also be made to strip the tributary veins under Doppler ultrasound localization before surgery.
2. Endoscopic assisted subfascial tributary vein ligation
Endoscopic assisted subfascial tributary vein ligation began in 1985, first adopted by Hauer, the method is to place the endoscope through the subcutaneous tunnel, directly coagulate or clamp the tributary veins. In recent years, there have been reports on the use of laparoscopic technology for tributary vein ligation. First, carbon dioxide is filled in the subfascial space, a small incision is made to insert the endoscope, and the operation instruments are inserted through another small incision. The operation range should include the lower leg part from the medial margin of the tibia to the posterior median line.
Since most of the superficial venous surgery is performed simultaneously with the operation of the tributary veins, it is difficult to accurately count the efficacy, and there are many reports on incision complications, with an average incidence rate of 24%, and the recurrence rate of postoperative ulcers is about 20%, but there is still significant efficacy when compared with the non-surgical treatment group.
II. Prognosis
No relevant content description is available at present.
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