Edema in case of varicose veins
In modern literature, it is not uncommon for signschronic venous insufficiency refers to edema. Meanwhile, in fundamental works on lymph circulation there is evidence that a healthy lymphatic system can compensate for the most serious disorders of outflow of blood, increasing the evacuation of fluid from tissues hundreds of times. On the contrary, lymphodema can be observed with a slight varicose veins, if there are organic changes in the lymphatic system. On the basis of such information it is reasonable to consider that edema only partly speaks about the degree of venous insufficiency in patients with varicose veins. However, his presence always indicates a lack of lymph circulation, which should not be taken into account when choosing an operative allowance for varicose veins.
INDICATIONS FOR OPERATION IN VARICOSIS DISEASE COMPLICATED BY STENDS
In itself, edema in patients with varicose veins is notis an indication for the operation. As with any character of the disease, the operation will be expedient only if there are pathogenetic factors, the elimination of which is possible at the present stage only surgically. If they are absent, surgery is not indicated for swelling. If varicose transformation of the subcutaneous veins is accompanied by severe vertical and horizontal venous reflux, surgical treatment is indicated both for the prevention of complications of varicose veins and for preventing the growth of lymphatic insufficiency. Contraindication for surgery on the venous system is elephantiasis and stage 3 lymphodema.
Preoperative preparation consists ofmandatory ultrasound examination, during which the presence of lymphostasis is established. confirmed the presence of blood reflux, which need to be eliminated, and the points of emergence of untenable perforating veins along the medial surface of the shank where the main lymphatic duct is passing are most accurately sampled.
SELECTION OF VOLUME OF OPERATION IN VARICOSE DISEASE COMPLICATED BY STENPS
The choice of the scope of surgery shouldConsider the fact that each incision can damage a single lymphatic vessel. Therefore, the number and length of accesses must be strictly limited. In subcutaneous fat it is desirable not to produce any exfoliating tissue of action. To avoid damage to the lymphatic vessel, you can stain it by injecting Evans' blue in the 1st interdigital space on the foot 30-45 minutes before the operation. Such a vessel becomes bright blue and is clearly visible on the fascia.
It is extremely important to choose the operationon the trunk of a large saphenous vein. Optimum is intraoperative sclerobliteration - the only method today that does not injure the medial lymphatic collector. Any stripping. as shown by special studies, violates the integrity of several lymphatic vessels. Especially often this happens when removing the trunk of the large saphenous vein on the lower leg, where the reservoir vessels are close to each other and from the saphene.
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