扬州大学：《外科学》课程教学课件（PPT讲稿，Surgery）Chapter 35. Disease of the Venous System

Disease of the venous system

Disease of the venous system

Chronicvenousinsufficiency of lowerextremityStatueofAncientRome

 Statue of Ancient Rome Chronic venous insufficiency of lower extremity

anatomyVenous systemof the legs is composed bytwoparallelandconnectedsystems,thedeep and superficialvenous.Thesetwosystemswas connected byperforatingvenoussystem交通静脉PerforatingVein皮肤←Skin深静脉DeepVein浅静脉SuperficialVein

anatomy  Venous system of the legs is composed by two parallel and connected systems, the deep and superficial venous. These two systems was connected by perforating venous system

primary venous insufficiencyetiological factor1.Valvularincompetence→bloodrefluxhighpressure invenousvenousdilatation2.Weakvesselwall→dilatationvalvularincompetenceProximalDistalveinveinSubcutaneouslayerSubfasciallayerPerioratingPerforatingveinvein

primary venous insufficiency etiological factor 1. Valvular incompetence →blood reflux→high pressure in venous→venous dilatation 2.Weak vessel wall→ dilatation→valvular incompetence

clinical manifestationSimple varicose venousvaricose ofsuperficial vein,no complicationcomplications-dystrophic complication in skins（eczemaulcer）rupturetohemorrhageperforatorvenous insufficiencyankle edemadystrophic complication ofankle skins

clinical manifestation Simple varicose venous—varicose of superficial vein , no complication complications— dystrophic complication in skins（eczema、ulcer） rupture to hemorrhage perforator venous insufficiency —ankle edema， dystrophic complication of ankle skins

Superficia varicose veinsvenous ulcerH141175ShortSingular branchLong图6、静脉曲张致溃场saphenousveinssaphenous veins

Superficia varicose veins venous ulcer

diagnosisclinicalmanifestationimagingdetection:phlebographycolorDopple

diagnosis clinical manifestation imaging detection： phlebography color Dopple

HSurfacezhouwen RuanEx48933SUBEIPEOP HOS5109M6930037142Se:3DoB:Sep20 194Ex:May16201RenderingNo cutWolumeDFOV109.1cmSTND No Filter350VOINo100KV220nARot0.80s/HE+20.6mm/rot.2mm0.516:1/1.2spTilt:.0.005:22:29PM=220L60

Diagnostic studiesVenographyForcedValsalvalightregionundervalvulamaneuverlightregiondisappearingunder valvulaValvula incompetenceNormalvalvuila

Diagnostic studies  Venography  Forced Valsalva maneuver light region under valvula Normal valvula light region disappearing under valvula Valvula incompetence

treatmentConservativetreatment:CompressionStockings orpressure bandages and lowerextremityelevationFoamsclerotherapySurgical treatment: high ligation and stripping ofgreat (small) saphenous vein+varicose veinstripping deligation of perforating venous!

treatment  Conservative treatment： Compression Stockings or pressure bandages and lower extremity elevation Foam sclerotherapy Surgical treatment：high ligation and stripping of great (small) saphenous vein＋varicose vein stripping deligation of perforating venous!