The pathophysiology of calf perforators is presented. Bidirectional flow within calf perforators with a prevailing inward, into deep veins oriented component arises during calf pump activity in varicose vein patients, as evidenced by venous pressure measurements, plethysmographic findings, duplex ultrasonography, and electromagnetic flow measurements. Reflux within calf perforators is an inward, not outward, flow; the opinion that the outward flow within calf perforators is a reflux is at odds with the reality. During calf muscle contraction, the pressure in the posterior tibial vein is higher than in the great saphenous vein; it induces the harmless outward flow within calf perforators, which runs further via great saphenous vein in the physiological direction toward the heart. Deep and superficial veins of the lower leg form conjoined vessels, as documented by nearly equal pressure curves registered simultaneously in the posterior tibial and great saphenous veins both in varicose vein patients and in healthy people. Calf perforators do not entail ambulatory venous hypertension or any other hemodynamic disorder, even if enlarged and incompetent; their ligation is needless. The diameter of calf perforators is influenced by the intensity of saphenous reflux; it enlarges with increasing intensity of saphenous reflux and diminishes after the abolition of reflux.

• MeSH
• krevní tlak * MeSH
• lidé MeSH
• varixy patofyziologie   chirurgie   MeSH
• vena saphena patofyziologie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Varicose vein disease is characterized by tenacious tendency to recur. Measures recommended to prevent recurrences (flush ligation at the saphenofemoral junction, removal of incompetent great saphenous vein in the thigh, and insertion of mechanical barriers in the fossa ovalis) did not succeed in preventing recurrence. Reflux recurrence is triggered by the hemodynamic phenomenon called hemodynamic paradox. Abolition of saphenous reflux removes the hemodynamic disturbance of any degree of severity but at the same time it releases the pathological process leading to recurrent reflux. This process is induced by drainage of venous blood from incompetent superficial thigh veins into deep lower leg veins during calf pump activity, which evokes the development of ambulatory pressure gradient between the femoral vein and incompetent segments of the saphenous system in the thigh. The pressure gradient sets off biophysical and biochemical events inducing recurrent reflux. The designed therapeutic strategy consists of reliable abolition of saphenous reflux and of hindering the pathological drainage of venous blood at the knee level in order to preclude development of the hemodynamic preconditions for reflux recurrence. In this way, the dividing line of the ambulatory pressure gradient would be kept below the knee, as is the case with healthy people.

• MeSH
• hemodynamika * MeSH
• lidé MeSH
• varixy * patologie   patofyziologie   terapie   MeSH
• vena saphena * patologie   patofyziologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Saphenous reflux interferes with the physiological decrease in pressure and induces ambulatory venous hypertension. Elimination of reflux is achieved by flush ligation at the incompetent saphenofemoral junction and stripping of the great saphenous vein, which is the basis of the conventional surgical therapy. Endovenous ablative methods substitute stripping by thermal of chemical destruction of the saphenous trunk; they usually refrain from saphenofemoral junction ligation. Short-term and medium-term results up to 5 years, achieved after endovenous ablation without high ligation, are comparable with those after conventional surgery, which questioned the necessity to ligate the incompetent saphenofemoral junction. Nevertheless, clinical symptoms caused by recurrent reflux occur as a rule not earlier than 8 to 10 years after efficient abolition of reflux. Consequently, randomized studies with long-term follow-ups exceeding 10 years are necessary for trustworthy assessment whether it is justified to abstain from saphenofemoral junction ligation.

• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• bérec krevní zásobení   MeSH
• cévy zranění   MeSH
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• paže krevní zásobení   MeSH
• poranění dolní končetiny chirurgie   MeSH
• poranění paže chirurgie   MeSH
• předškolní dítě MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• senioři MeSH

• MeSH
• cévy zranění   MeSH
• chirurgie operační MeSH
• iatrogenní nemoci chirurgie   MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• amputace metody   MeSH
• arteriální okluzní nemoci chirurgie   MeSH
• bérec krevní zásobení   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH

• MeSH
• dráždivé látky terapeutické užití   MeSH
• roztoky terapeutické užití   MeSH
• varixy chirurgie   MeSH

A curious hemodynamic phenomenon emerging as a consequence of the treatment of varicose veins can offer a reasonable explanation why varicose vein and reflux recurrences occur tenaciously irrespective of the applied therapeutic procedure. Saphenous reflux is the most important hemodynamic factor in varicose vein disease: it is responsible for the hemodynamic disturbance, ambulatory venous hypertension, clinical symptoms, and chronic venous insufficiency. Abolition of saphenous reflux eliminates the hemodynamic disturbance and restores physiological hemodynamic and pressure conditions, but at the same time it unavoidably evokes a pressure difference between the femoral vein and the incompetent superficial veins in the thigh during calf pump activity. The pressure difference increases flow and enhances fluid shear stress on the endothelium in pre-existing minor communicating channels between the femoral vein and the saphenous system in the thigh, which triggers release of biochemical agents nitride oxide and vascular endothelial growth factor; the consequence is enlargement (vascular remodeling) of the communicating channels, and ultimately reflux recurrence. Hence, the abolition of saphenous reflux creates preconditions for the comeback of the previous pathological situation. This phenomenon-starting the same trouble while fixing the problem-has been called hemodynamic paradox; is explains why varicose vein and reflux recurrence can occur after any mode of therapy.

• Publikační typ
• časopisecké články MeSH

• MeSH
• aorta abdominalis MeSH
• arteria femoralis MeSH
• arteria poplitea MeSH
• arteriosclerosis obliterans chirurgie   MeSH
• dolní končetina MeSH
• dospělí MeSH
• důchod MeSH
• lidé středního věku MeSH
• senioři MeSH
• sociální problémy MeSH
• výkony cévní chirurgie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• mužské pohlaví MeSH
• senioři MeSH

• MeSH
• kardiochirurgické výkony MeSH
• Publikační typ
• biografie MeSH

• O autorovi
• Reček, Čestmír, 1927- Autorita