| The Lower Limb Perforating Venous Valvular Incompetence was the more common disease of limbs venous diseases. It was common diseases seriously endangering the health of mankind, has become a growing concern topics in clinical vascular surgery. According to the basis of pathophysiology and hemodynamic changes, the perforating venous valvular incompetence primarily related to the following factors: the late complications of the great saphenous vein; the primary deep venous valvular incompetence; the deep venous thrombosis occurred in the surrounding. Because the deep venous thrombosis extended to the perforating vein, the perforating vein and its valve was damaged and occurred to reflux of the deep vein; occurred to after the thrombosis of iliofemoral vein, in the early stage of the disease, reflux disorder of lower limb vein led to increase of the intraluminal pressure, additionally, the action of muscle pump caused the expansion of the perforating vein, and then evoked to valvular incompetence. After recanalization of deep vein, owing to damage of vein, it led to similar consequences with deep venous incompetence. Besides the typical clinical symptoms to the diagnosis of Lower limb perforating venous valvular incompetence, venography was a gold standard regarding as diagnosis in the past; however, the method was traumatic and easily led to complications, in addition to its expensive. The noninvasive examination to the lower limb perforating vein has been an interesting topic of clinical vascular surgery. The Color Doppler Ultrasound was regarded as a non-invasive diagnosis and was the one of evaluations of the lower limb perforating venous valvular incompetence. With advance of technology, it was being increasingly recognized. In this study, we analyzed features of color Doppler ultrasound of the lower limb perforating venous valvular incompetence by color Doppler ultrasound, which aimed to investigate the value of clinical application of color Doppler ultrasound.Materials and Methods:Selected cases: The all patients came from vascular surgery in our hospital from January 2005 to October 2006. The incompetent perforating veins were diagnosed and located by Color Doppler ultrasound before surgery. We had complete information of surgery of 100 patients (122 limbs, the right side 45, left 33, both 22). They were 68 male patients and 32 female patients, their age ranged 16 to 80 years old and the average age was 51.37 years old. The disease duration varied between 1 and 60 years and the average duration was 17 years.Detecting procedures: To use GE Logiq 7, the frequency of detecting head was 12 MHz. If the patients or affected limb was fat, it was often difficult that high-frequency detecting head showed the deep vein, the low-frequency detecting head might be chose to use. The sequence of conventional detection was iliac vein - femoral vein - popliteal vein - deep vein of the lower limb- superficial vein - whether or not the expansion of the vascular structure connected to the deep and superficial vein. The clinical data of 100 cases (122 limbs) undergone surgery, which were ill with the lower limb superficial varix or it accompanied by the skin pigmentation or formation of the venous ulcer, were analyzed. The incompetent perforating veins of all the cases were detected and located by two-dimensional ultrasound and color Doppler ultrasound, and"local pressed and released experiment"before surgery, which were compared with incompetent perforating veins undergone surgical cure. In 100 cases with different clinical stages of the Lower Limb Perforating Venous Valvular Incompetence, the number and diameter of the perforating veins were analyzed. Results:1. In all the 122 limbs of the 100 cases, color Doppler ultrasound found out 421 incompetent perforating veins, Totally 414 perforating veins were ligated in surgery. Among these veins, 384 perforating veins were found at the same location as diagnosed. Compared with the results in surgery, the match rate of color Doppler ultrasound for diagnosis of incompetent perforating veins was 92.75%. 2. There were positive relationships between the number and diameter of the incompetent perforating veins and the clinical stages, with a relationship index of 0.305, 0.362 respectively (p<0.001).3. Among the Cockettâ… ,â…¡,â…¢groups, Average diameter of the incompetent perforating veins of subgroups of were different. The diameter ofâ… andâ…¢groups showed no statistical significance. The average diameter ofâ…¡group was significantly larger than those ofâ… andâ…¢groups, which have statistical difference(P<0.0001).Conclusion:1. the number of lower limb incompetent perforating veins that was diagnosed and located by Color Doppler ultrasound have a higher consistent with the number of ligation of those during surgery, which has important clinical value.2. The pressed and released experiment of the detecting head that induced reflux of the lower limb perforating vein was an ideal diagnosis to lower limb perforating venous valvular incompetence by Color Doppler Ultrasound.3. Greater number and wider diameter of perforating veins that diagnosed by Color Doppler Ultrasound were accompanied with higher clinical stages.4. The average diameter ofâ…¡group was significant larger than those ofâ… andâ…¢groups.Therefore, the patients who were doubted to be ill with lower limb perforating venous valvular incompetence should be promptly accepted the examination of Color Doppler Ultrasound. The venous diseases of the lower limb can be found at the early stage in order that took effective prevention and treatment measures. At the same time, regarding to the definite patients, Color Doppler Ultrasound already provided kinds of vascular parameters, cleared the stage of development of disease, and provided a reliable basis for the clinical diagnosis, the choice of surgical treatment, the clinical monitoring of conservative treatment, and the index of the prognosis. Therefore, color Doppler ultrasound had very important clinical value in the diagnosis of lower limb perforating venous valvular incompetence. |
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