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[Evaluation of the obstructive factor and its importance in the caval and ilio-caval postphlebitic syndrome]
1Service de Chirurgie A Générale, Centre Hospitalier Saint-Philibert, Lomme.
Insights
Former caval and ilio-caval phlebitis can be well compensated by collateral circulation. Venous distensibility disorders, however, can impair compensation, highlighting the complexity of post-phlebitic illness.
Area of Science:
- Vascular Medicine
- Medical Physiology
Context:
- Post-phlebitic sequelae, particularly caval and ilio-caval phlebitis, present unique challenges in venous haemodynamic disorders.
- The development of collateral circulation is a key factor in managing venous obstruction.
- Previous clinical and phlebographical findings suggested potential compensation mechanisms.
Purpose:
- To investigate the functional repercussions of caval and ilio-caval venous obstructions using plethysmography.
- To assess the role of collateral circulation and venous distensibility in post-thrombotic venous compensation.
- To evaluate venous return and obstructive syndromes more than six months after acute thrombosis.
Summary:
- Functional investigations, primarily venous occlusion plethysmography, were employed to study venous haemodynamics in patients with chronic caval and ilio-caval phlebitis.
- Results indicate that isolated caval obstruction is often well-compensated by collateral pathways.
- However, when caval obstruction coexists with subinguinal venous system deterioration, venous return disorders are more pronounced. Venous distensibility also plays a crucial role in compensation, with impaired distensibility negatively impacting outcomes.
Impact:
- Demonstrates that phlebography alone provides an incomplete assessment of functional venous obstruction.
- Highlights the critical role of venous distensibility in the compensatory mechanisms of post-phlebitic syndromes.
- Emphasizes the complexity of post-phlebitic illness and the need for functional assessments to understand true haemodynamic impact.
Abstract:
As regards venous haemodynamic disorders, former caval and ilio-caval phlebites constitute a separate group in the vast structure of phlebitic after-effects. The wealth of collaterals (reminder of the physio-pathology) and the slightest affection of the upper venous system in the case of high isolated thrombosis show that they may be effectively compensated. This idea, already apparent in certain clinical and phlebographical findings, is confirmed by functional investigations, and especially by plethysmography under venous occlusion. It is this method that we have used in this study. We have retained only the lesions of the ilio-caval system considered some way away from the acute stage of the thrombosis (gap of more than 6 months). A first approach, using rheoplethysmography, confirms that the obstructive syndrome associated with caval obstruction alone is generally well compensated by the development of an efficient collateral circulation, and that disorders of venous return, evaluated by the outflow index, are mainly to be seen when the caval obstruction is associated with deterioration of the subinguinal venous system. A second approach showed, by means of a more far-reaching analysis of the parameters using a constrictive mercury gauge that besides venous repermeation and supply through the collateral network a role was played by venous distensibility disorders induced by phlebitis... The maintenance of satisfactory distensibility could therefore come into play as a contributory factor in compensation phenomena. These facts confirm the complexity of post-phlebitic illness; phlebography gives only an incomplete insight into the functional repercussions of the obstructive syndrome; the exection of functional experiments demonstrate that often apparently significant venous obstructions are in fact quite well compensated.