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Venous Reflux Patterns

  • Sergio Gianesini
  • Paolo Zamboni
  • Erika Mendoza
Chapter

Abstract

Classical physiology of leg veins was described based on physics rules and anatomic observations. While physics rules find application only to a certain extent, as veins are not ideal tubes nor blood ideal fluids, the knowledge is important to understand reflux and draining pathways. Ultrasound has revolutionized the knowledge in phlebology, allowing a better subdivision of reflux escape points, refluxing pathways and re-entry points. In the same way, a distinction of the function of dilated perforators into pressure equalizers, escape points and re-entry pathways was possible. The combination of this knowledge allowed the subdivision of pathologic pathways into shunt types. Once understood the haemodynamics, the consequence of which strategy to apply in saphenous vein sparing surgery is an easy second step.

Literature

  1. 1.
    Dodd H, Cockett FB. The pathology and surgery of the veins of the lower limb. Edinburgh: Churchill Livingstone; 1976.Google Scholar
  2. 2.
    Lattimer CR, et al. Saphenous pulsation on duplex may be a marker of severe chronic superficial venous insufficiency. J Vasc Surg. 2012;56(5):1338–43.CrossRefPubMedGoogle Scholar
  3. 3.
    Katz A. Flow through a collapsible tube. Biophys J. 1969;9(10):1261–79.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Baird RN, Abbott WM. Elasticity and compliance of canine femoral and jugular vein segments. Am J Physiol. 1977;233(1):H15–21.PubMedGoogle Scholar
  5. 5.
    Norgren L, Thulesius O. Pressure-volume characteristics of foot veins in normal cases and patients with venous insufficiency. Blood Vessels. 1975;12(1):1–12.PubMedGoogle Scholar
  6. 6.
    Davies AH, Magee TR, Baird RN, Sheffield E, Horrocks M. Vein compliance: a preoperative indicator of vein morphology and of veins at risk of vascular graft stenosis. Br J Surg. 1992;79(10):1019–21.CrossRefPubMedGoogle Scholar
  7. 7.
    Davies AH. Vein factors that affect the outcome of femorodistal bypass. Ann R Coll Surg Engl. 1995;77(1):63–6.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Zamboni P, Marcellino MG, Cappelli M, Feo CV, Bresadola V, Vasquez G, Liboni A. Saphenous vein sparing surgery: principles, techniques and results. J Cardiovasc Surg (Torino). 1998;1998(39):151–62.Google Scholar
  9. 9.
    Zamboni P, Marcellino MG, Portaluppi F, Manfredini R, Feo CV, Quaglio D, Liboni A. The relationship between in vitro and in vivo venous compliance measurement. Int Angiol. 1996;15(2):149–52.PubMedGoogle Scholar
  10. 10.
    Zamboni P, Portaluppi F, Marcellino MG, Quaglio D, Manfredini R, Feo CV, Stoney RJ. In vitro versus in vivo assessment of vein wall properties. Ann Vasc Surg. 1998;12(4):324–9. PubMed PMID: 9676928.CrossRefPubMedGoogle Scholar
  11. 11.
    Zamboni P. Physical principles of venous haemodynamics. In: Franceschi C, Zamboni P, editors. Principles of venous haemodynamics. New York: Nova Science; 2010. p. 13–21.Google Scholar
  12. 12.
    Kamm RD, Pedley TJ. Flow in collapsible tubes: a brief review. J Biomech Eng. 1989;111(3):177–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Mendoza E, Lattimer CR, Morrison N. Duplexultrasound of superficial leg veins. New York: Springer; 2014.Google Scholar
  14. 14.
    Labropoulos N, Tiongson J, Pryor L, Tassiopoulos AK, Kang SS, Mansour A, Baker WH. Definition of venous reflux in lower-extremity veins. J Vasc Surg. 2003;38:793–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Habenicht M, Rabe E, Amsler F, Mendoza E. Toe elevation manoeuvre to assess venous rflux in comparison to manual calf compression and release. Vasa. 2016;45(4):299–304.CrossRefPubMedGoogle Scholar
  16. 16.
    Mendoza E. Handbuch CHIVA, Arrien GmbH; 2002.Google Scholar
  17. 17.
    Chiu JJ, Chien S. Effects of disturbed flow on vascular endothelium: pathophysiological basis and clinical perspectives. Physiol Rev. 2011;91(1):327–87.  https://doi.org/10.1152/physrev.00047.2009.CrossRefPubMedGoogle Scholar
  18. 18.
    Tisato V, Zamboni P, Menegatti E, et al. Endothelial PDGF-BB produced ex vivo correlates with relevant hemodynamic parameters in patients affected by chronic venous disease. Cytokine. 2013;63(2):92–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Tisato V, Zauli G, Voltan R, et al. Endothelial cells obtained from patients affected by chronic venous disease exhibit a pro-inflammatory phenotype. PLoS ONE. 2012;7(6):e39543.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Tisato V, Zauli G, Gianesini S, Menegatti E, Brunelli L, Manfredini R, Zamboni P, Secchiero P. Modulation of circulating cytokine-chemokine profile in patients affected by chronic venous insufficiency undergoing surgical hemodynamic correction. J Immunol Res. 2014;2014:473765.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Zamboni P, Spath P, Tisato V, Tessari M, Dalla Caneva P, Menegatti E, Occhionorelli S, Gianesini S, Secchiero P. Oscillatory flow suppression improves inflammation in chronic venous disease. J Surg Res. 2016;205(1):238–45.CrossRefPubMedGoogle Scholar
  22. 22.
    Franceschi C, Cappelli M, Ermini S, Gianesini S, Mendoza E, Passariello F, Zamboni P. CHIVA hemodynamic concept, strategy and results. Int Angiol. 2016;35(1):8–30. Epub 2015 Jun 5.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Gianesini S, Occhionorelli S, Menegatti E, Zuolo M, Tessari M, Spath P, Ascanelli S, Zamboni P. CHIVA strategy in chronic venous disease treatment: instructions for users. Phlebology. 2015;30:157–71.CrossRefPubMedGoogle Scholar
  24. 24.
    Trendelenburg F. Ueber die Unterbindung der Vena saphena magna bei Unterschenkelvaricen. Beiträge zur Klinischen Chirurgie (Tübingen) 1891;7:195–210. Translation to English to be found on www.chiva.info/Informationen für ärzte.
  25. 25.
    Hach W, Girth E, Lechner W. Classification of saphenous vein reflux in 4 grades (German: Einteilung der Stammvarikose in 4 Stadien). Phlebol Proktol. 1977;6:116–23.Google Scholar
  26. 26.
    Franceschi C, Zamboni P. Principles of venous haemodynamics. New York: Nova Science; 2010.Google Scholar
  27. 27.
    Franceschi C. Théorie et pratique de la cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire. Precy-sous-Thil: Editions de l’Armançon; 1988.Google Scholar
  28. 28.
    Franceschi C. Theory and practice of the conservative haemodynamic cure of incompetent and varicose veins in ambulatory patients. Translated by Evans J. Precy-sous-Thil: Editions de l’Armançon; 1988.Google Scholar
  29. 29.
    Labropoulos N, Giannoukas AD, Delis K, Mansour MA, Kang SS, Nicolaides AN, et al. Where does venous reflux start? J Vasc Surg. 1997;26(5):736–42.CrossRefPubMedGoogle Scholar
  30. 30.
    Bernardini E, et al. Development of primary superficial venous insufficiency: the ascending theory. Observational and hemodynamic data from a 9 year experience. Ann Vasc Surg. 2002;24:709–20.CrossRefGoogle Scholar
  31. 31.
    Pittaluga P, Chastanet S, Locret T, Barbe R. The effect of isolated phlebectomy on reflux and diameter of the great saphenous vein: a prospective study. Eur J Vasc Endovasc Surg. 2010;40(1):122–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Pittaluga P, Chastanet S. Treatment of varicose veins by ASVAL: results at 10 years. Ann Vasc Surg. 2017;38:e10.  https://doi.org/10.1016/j.avsg.2016.07.021; Epub 2016 Oct 11.CrossRefGoogle Scholar
  33. 33.
    Ramelet AA, Crebassa V, Carlos D’Alotto C, Buero G, Gillet JL, Grenot-Mercier A, Kuepfer S, Mendoza E, Monsallier JM, Obermayer A, Pacheco K, Pros N, Rastel D, Soulie D. Anomalous intraosseous venous drainage: bone perforators? Phlebology. 2017;32(4):241–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Mendoza E. Duplex ultrasound investigation of perforating veins. Phlebologie. 2014;43:206–9.CrossRefGoogle Scholar
  35. 35.
    Mendoza E. Topographical anatomy of the great saphenous vein: duplex-ultrasound study. (German: Zur topographischen Anatomie der Vena saphena magna: Eine duplex-sonographische Studie im Hinblick auf chirurgisch relevante Aspekte). Phlebologie. 2001;30:140–4.CrossRefGoogle Scholar
  36. 36.
    Franceschi C. La Cure Hemodynamique de l’Insuffisance Veineuse en Ambulatoire. J Mal Vasc. 1992;22(2):91–5.Google Scholar
  37. 37.
    Hammarsten J, Pedersen P, Cederlund CG, Campanello M. Long saphenous vein saving surgery for varicose veins. A long-term follow-up. Eur J Vasc Surg. 1990;4(4):361–4.CrossRefPubMedGoogle Scholar
  38. 38.
    Carandina S, Mari C, De Palma M, Marcellino MG, Cisno C, Legnaro A, Liboni A, Zamboni P. Varicose vein stripping vs haemodynamic correction (CHIVA): a long term randomised trial. Eur J Vasc Endovasc Surg. 2008;35(2):230–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Zamboni P, Cisno C, Marchetti F, Quaglio D, Mazza P, Liboni A. Reflux elimination without any ablation or disconnection of the saphenous vein. A haemodynamic model for venous surgery. Eur J Vasc Endovasc Surg. 2001;21:361–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Sergio Gianesini
    • 1
    • 2
  • Paolo Zamboni
    • 3
    • 4
  • Erika Mendoza
    • 5
  1. 1.Vascular Diseases CenterUniversity of FerraraFerraraItaly
  2. 2.USUHS UniversityBethesdaUSA
  3. 3.School of Vascular Surgery and Vascular Diseases CenterUniversity of FerraraFerraraItaly
  4. 4.Unit of Translational SurgeryAOU FerraraFerraraItaly
  5. 5.VenenpraxisWunstorfGermany

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