aree scientifiche

ABSTRACT

Keywords: Venous insufficiency, Postphlebitic disease

Goal. – To show how recent knowledge of venous hemodynamics makes it possible to advance not only the classic concepts of pathophysiology, but also the diagnosis and treatment of postphlebitic disease.

Problematic. – Postphlebitic disease is a mixture in variable proportions of obstacles to flow and reflux, both responsible for tissue drainage disorders whose clinical functional and trophic consequences are of uneven severity. The advances in conceptual tools should allow a more detailed understanding of these phenomena, with the result that the diagnostic means of investigation can be optimized and therapeutic strategies rationalized.

Description. – Difference between the internal pressures PI and external atmospheric pressure, altitude (PE) which are exerted, on both sides, of the wall of the vein and its capillaries, the transmural pressure PTM is the cardinal variable of the function venous. It thus modulates tissue drainage and venous gauges. Too high due to either too low PE or too high PI (PR residual pressure too high due to lower arteriolocapillary resistance or obstruction of flow, hydrostatic pressure orthostatic PHS not reduced due to lack of dynamic fractionation PHS FDPHS). This fractionation is obtained by the systolodiastolic action of the PVM which alternately closes the upstream and downstream valves. The ineffectiveness of PVM results either from muscular inactivity (immobile standing or lying posture, paralysis), or from direct or indirect valve incontinence (deep and superficial closed shunts). Postphlebitic disease combines the effects of FDPHS defect and excess RA in varying proportions. Its treatment must logically reduce PTM by increasing PE (compression), reducing PI (PHS by decubitus, FDPHS by repairing defective elements of PVM, PR by respect and / or creation of open vicarious shunts).

Conclusion. – Thanks to these concepts, treatments for venous insufficiency can now be rationally adapted to the different hemodynamic configurations mapped by ad hoc diagnostic methods.

32) FRANCESCHI C.: So as to avoid any misunderstanding about Cure Conservatrice et Hemodynamique de l’Insuffisance Veineuse en Ambulatoire (CHIVA).

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