Method for the diagnosis of valvular insufficiency of the superficial and perforating veins of the lower extremities

 

(57) Abstract:

The invention relates to medicine, phlebology. The patient in the supine position with elevated lower extremity exercise phased study extremity zones. The study area present in the infra-red radiation. On the lower part of the investigated area impose harness, using digital compression release of the investigated part of the vein with blood, lay the harness on the upper part of the studied area. Failure of valves in the superficial veins is diagnosed when registering vertical reflux of blood through the veins of the femur and tibia after removing the top rope. On insufficiency of the valves perforating veins are judged by registering horizontal reflux after a few more flexion. The method allows in the early stages of varicose veins to distinguish valvular insufficiency of the superficial and perforating veins of the femur and tibia without direct contact with the patient's skin.

The invention relates to medicine, namely to surgery, and can be used for the diagnosis of valvular insufficiency of the superficial and perforating veins of the lower extremities.

A known method for the diagnosis of valvular nedostatki lower extremities. Clinic, diagnostics, treatment. (Methodical recommendations for students of senior courses). Moscow, 2001, S. 5). The method is based on compression overlapping investigated Vienna from the top, rendering it to relieve compression overlapping and after evaluating the results when restoring blood flow and marking of detected abnormalities.

The disadvantages of this method include its low diagnostic value at the initial manifestations of varicose disease when expressed varicose transformation is yet to come. The method is not very informative in identifying insolvent perforating veins and does not allow to clearly distinguish between valvular insufficiency of the superficial and perforating veins. The method is not used to diagnose insolvent veins of the leg.

The objective of the invention is to provide a non-contact diagnostic technique used in the early stages of varicose to distinguish valvular insufficiency of the superficial and perforating veins of the lower extremities due to visualization of the study area in the infra-red radiation in real time and separate registration of vertical and horizontal reflux of blood through the veins of the femur and tibia, including veins is th insufficiency of the superficial and perforating veins of the lower extremities, including compressive clamping of the superficial veins in the survey area, according to the invention render the studied area in the infra-red radiation, in the supine position with elevated lower extremity exercise phased study limb in areas on the lower part of the investigated area impose harness, using digital compression release of the investigated part of the vein with blood, lay the harness on the upper part of the studied zone, diagnose failure of valves in the superficial veins when registering vertical reflex blood through the veins of the femur and tibia after removing the upper harness, failure of valves perforating veins are judged by registering horizontal reflux after flexion movements of the foot.

For the first time a non-contact method, allowing to visualize the vertical and horizontal reflux of blood, respectively, superficial and perforating veins of the femur and tibia in the infra-red radiation in real time. The study of infrared radiation in the middle range renders any, even minor, current venous blood that can detect the disease early and to vessels of small main system, allowing to visualize the veins in the infrared radiation of the middle range (755 nm to 1000 nm). When individual examination of patients was carried out the following steps:

1) external examination of patients with marking the supposed pathology;

2) check the data marked areas when duplex scanning;

3) study of patients with imaging in the near-infrared range of the proposed method and the mandatory labeling of all found insolvent superficial and perforating veins;

4) intraoperative scan.

Studies have shown that physical examination revealed an average of two insolvent perforating veins, with Doppler study in these areas were visualized on average, one insolvent perforating vein is possible due to the fact that Doppler study does not allow to visualize the vessels with diameter less than 2.5 mm, and when the study requires accurate installation of the sensor above the perforating veins. In the study in the infrared radiation of the middle band was visualized on average three insolvent perforating veins. When the operation (phlebotomy on an estate who crossed all detected perforating veins).

This research confirmed that the proposed method is especially effective for the diagnosis of insolvent perforating veins of small diameter.

The method can be carried out as follows.

The study was conducted with the patient lying on the back with a raised stationary lower extremity. This provision of the patient eliminates the possibility of horizontal reflux (back flow) of blood is insufficient perforating veins. Implement a phased inspection limbs. Each area of research is 15-20 refer To the lower and upper part of the studied veins (in the thigh or lower leg) impose the wiring to exclude normal (direct) blood flow and vertical reflux (back flow) of blood in the superficial veins, and compression method (finger compression) "push" the blood from the superficial veins. If after removing the upper harness visualized vertical reflux, diagnose failure of valves in the superficial veins of the study area. The location of veins with a vertical reflux mark.

For registration failure valves perforating veins mark the location of varicose veins and their origins. Top what's veins was completely blocked. Then the patient in the supine position offer to do 5-6 flexion movements of the foot. In this note the emergence of local "spring" (source) black and mark this location as the area of the alleged insufficiency of the valves of the perforating veins. The compression method free from the blood of the vein area, the patient stands up and takes a few steps overlay harness. With the patient standing re-examine the previously mentioned source. When rendering in the area of the source of a large area of bright black off of it filled veins register horizontal reflux of blood and diagnose the failure of the valves in the perforating veins. Mark found the area.

The method can be illustrated by the following examples.

Example 1. Patient L. 27 years. Diagnosis: varicose veins of right lower extremity chronic venous insufficiency I-II degree. Complaints of pains in the veins. When local examination of the right lower limb on the tibia detected a slight varicose veins, distributed on the trunk type, soft elastic, painless, spodumene to palpation, with no signs of wasallaamo not identified. When ultrasonic dopplerography all examined Vienna passable, perforating veins of small diameter are not rendered. In the sample Valsalva valves all examined veins (Vv. Poplitea, Femoralis, Femoralis profunda, Femoralis communis, Safena magna) wealthy.

Was conducted diagnostics on the proposed method: when imaging in the infrared radiation of the middle range with the patient lying supine with elevated legs at an angle of 45 degrees revealed varicose veins in the lower leg left lower extremity in the projection of greater saphenous vein at hip varicose vein is not visualized. Conducted a stepwise examination of the right lower extremity: the entire lower extremity is divided into sections with a length of about 20 cm and was separately examined each site. On the lower portion of the limb was imposed harness and compression method (finger compression) superficial veins are exempt from the blood. Step by step on the upper part of each inspectable area put the second (upper) wiring harness. At the time of removal of the top harness on any site has not been marked by the appearance of vertical reflux of blood, i.e. valvular insufficiency of the superficial veins are not detected. Then spent a phased dialogo reflux patient produced 5 flexion movements of the foot, while on the medial surface of the tibia, on the border of the lower and middle thirds, found 1 source, and in the lower third of the leg revealed 2 source horizontal reflux of blood, which was diagnosed with valvular insufficiency perforating veins with subsequent marking of detected abnormalities. The patient was scheduled for surgery under epidural anesthesia in the area of the lower third of the leg in the locations previously marked perforating veins made incisions in length by 3 cm. If the audit reveals: on the border of the lower and middle third of the leg - perforating vein running from her branches with a diameter of about 0.3 see Vienna selected, clipped, tied, defect fascia sutured. Branches tied. In the lower third of the leg revealed two insolvent perforating veins with a diameter of 0.35 cm also coming from their branches. These veins also selected, trimmed, tied napastyle, the defect in the fascia sutured.

The proposed method has allowed for the early diagnose the viability of the superficial veins and the failure of the perforating veins, to determine their location and to produce an optimal surgical intervention.

Example 2. Patient L., aged 30. Diagnosis: Varicose both lower konecne the lower extremities, aching pain in the veins. When viewed in the left lower extremity detected a slight varicose veins, distributed on the trunk type, soft elastic, painless, spodumene palpation, without signs of inflammation over them. When conducting samples (Troyanova-Trendelenburg, Pratt, Chania, Hackenbruch) insolvency of the valves are not identified. When ultrasonic Doppler: all examined Vienna passable. In the sample Valsalva valves all examined veins (Vv. Poplitea, Femoralis, Femoralis profunda, Femoralis communis, Safena magna) wealthy. Left in the middle third of the leg is rendered indistinct perforating vein with a diameter of 0.2 cm, in standing position is not rendered.

Was conducted diagnostics on the proposed method: position the patient supine with elevated at an angle of 45 degrees to the lower extremities during the General examination revealed varicose veins on both lower limbs, thighs and legs in the projection of the Great Saphenous vein. Stepwise examination of the left lower limb, in which all the lower limb was divided into sections with a length of about 20 centimeters, showed that in all parts of the tibia at the time of removal of the top harness Visualizer the saphenous vein of the leg. On the hip vertical reflux of blood could not be visualized. Similarly produced piecemeal examination of the right lower limb vertical reflux of blood in any section does not appear, allowing to diagnose the viability of the valve of the great saphenous vein of the thigh.

Stepwise examination of the lower limb after 5 flexion movements of the foot to diagnose the failure of the valves in the perforating veins showed that the medial surface of the tibia, on the border of the lower and middle thirds identified 2 source horizontal reflux, which allowed us to diagnose the failure of the valves in the perforating veins, followed by their markings.

Diagnostics on the proposed method allowed us to prepare a plan of operation. Was made phlebotomy with a minimum volume of operative intervention insolvent superficial and perforating veins.

The proposed method allows to visualize the superficial and perforating veins in real time, which greatly improves the ability to work with data veins. The absence of direct contact with the patient's skin allows you to use the method in the operating conditions.

By way of an automotive technician who was clamping of the superficial veins in the survey area, characterized in that render the study area in the infra-red radiation, in the supine position with elevated lower extremity exercise phased study limb in areas on the lower part of the investigated area impose harness, using digital compression release of the investigated part of the vein with blood, lay the harness on the upper part of the studied zone, diagnose failure of valves in the superficial veins when registering vertical reflux of blood through the veins of the femur and tibia after removing the upper harness, failure of valves perforating veins are judged by registering horizontal reflux after flexion movements of the foot.



 

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