Place de la chirurgie veineuse profonde dans les syndromes de reflux post-thrombotiques / Deep vein surgery place in post-thrombotic reflux syndrome
Seance of wednesday 11 january 2023 (Actualités sur la maladie veineuse post thrombotique)
DOI number : 10.26299/8q79-v328/emem.2023.1.06
Abstract
Le syndrome post-thrombotique présente deux composantes hémodynamiques: obstruction et reflux, fréquemment associés. Lorsque la maladie affecte la qualité de vie du patient, des traitements chirurgicaux sont conseillés. L'obstruction au niveau ilio-cave doit être traitée en premier car au moins la moitié des patients amélioreront systématiquement leur état clinique. Cependant, le reflux axial fémoro-poplité dû à la destruction valvulaire est responsable de symptômes sévères et de la persistance/récidive de l'ulcère chez un nombre important de patients. Ainsi, les techniques de reconstruction valvulaire jouent un rôle pertinent dans la prise en charge de ces patients, permettant le contrôle de l'insuffisance veineuse chronique. De plus, la chirurgie du reflux veineux profond peut être associée à la correction de l'obstruction dans des solutions hybrides, surtout quand un mauvais débit à la confluence fémorale peut empêcher une correction ilio-cave adéquate. Les techniques de reconstruction à ciel ouvert en veine profonde sont aujourd'hui une chirurgie sûre et efficace, permettant une amélioration significative de la qualité de vie des patients atteints de syndrome post-thrombotique.
Marzia Lugli - Modène (Italie)
Mots clés : syndrome post thrombotique, ulcère de jambe, reconstruction valvulaire
The post-thrombotic syndrome presents two hemodynamic components: obstruction and reflux, frequently associated. When the disease affects the patient quality of life, operative treatments are advisable. Obstruction at iliocaval level should be treated first because at least half of the patients will improve consistently their clinical condition. However, the femoro-popliteal axial reflex due to valve destruction is responsible for severe symptoms and ulcer persistence /recurrence in a significant number of patients. Thus, valve reconstruction techniques play a relevant role in the management of those patients allowing the control of chronic venous insufficiency. Moreover, deep vein reflux surgery can be combined with obstruction correction in hybrid solutions, in those situations in which poor inflow at femoral confluence may impede adequate iliocaval correction. Deep vein open reconstructive techniques are today a safe and effective surgery, allowing a relevant quality of life improvement in patients affected by post-thrombotic syndrome.
Keys words : Post thrombotic syndrome, leg ulcer, valv reconstruction
Marzia Lugli - Modène (Italie)
Mots clés : syndrome post thrombotique, ulcère de jambe, reconstruction valvulaire
The post-thrombotic syndrome presents two hemodynamic components: obstruction and reflux, frequently associated. When the disease affects the patient quality of life, operative treatments are advisable. Obstruction at iliocaval level should be treated first because at least half of the patients will improve consistently their clinical condition. However, the femoro-popliteal axial reflex due to valve destruction is responsible for severe symptoms and ulcer persistence /recurrence in a significant number of patients. Thus, valve reconstruction techniques play a relevant role in the management of those patients allowing the control of chronic venous insufficiency. Moreover, deep vein reflux surgery can be combined with obstruction correction in hybrid solutions, in those situations in which poor inflow at femoral confluence may impede adequate iliocaval correction. Deep vein open reconstructive techniques are today a safe and effective surgery, allowing a relevant quality of life improvement in patients affected by post-thrombotic syndrome.
Keys words : Post thrombotic syndrome, leg ulcer, valv reconstruction