THE IMPORTANCE OF MUSCULOVENOUS PUMP DISORDERS AND VENECTOMY FOR LYMPHATIC DRAINAGE OF THE LOWER LIMBS IN PATIENTS WITH VARICOSITY

B.S. Sukovatykh, P.M. Nazarenko, L.N. Belikov, O.A. Rodionov, S.A. Abramova
Chair of Surgical Diseases №2, Kursk State Medical University,
Kursk, Russia

92 patients suffering from varicosity were examined, for the relationship between the status of the musculovenous pump of the leg and lymphatic drainage of the lower limbs. The musculovenous pump was studied by photoplethysmography and the lymphatic system by direct lymphography. Two grades of musculovenous pump disorders were established. Grade I is characterized by reduction (32.9±7.4%) of the blood amount in the capillary bed of the leg during functional exercise with return to the initial level after 12.5±2.1 seconds; as for grade II, these indicators were 23.4%±1.6% and 8.3±1.5 seconds. Grade I musculovenous pump disorders are associated with enhancement of lymphatic drainage of the lower limbs. Grade II musculovenous pump disorders cause decompensation of the lymphatic drainage promoting the occurrence and progression of trophic disorders. 35 patients of the control group were examined for the effect of venectomy on the lymphatic drainage. It is proven that excision of the sephenous veins on the leg without deterioration of the lymphatic drainage is impossible because patients suffering from varicosity may develop numerous lympho-lympho- and lympho-venous anastomoses. The number of anastomoses on the thigh is not great. So, the damage to the latter ones during venectomy is encountered in single cases. The authors have devised an original method of surgical treatment of sephenous vein varicosity, according to which the greater saphenous vein is to be excised only on the thigh whereas the leg is to undergo autovenous occlusion of the main trunks of the greater and lesser saphenous veins. Chronic lymphovenous insufficiency could fully be eliminated in 84.8% of patients.

KEY WORDS: Varicosity, lymphatic dranage, musculo-venous pump, venectomy.

P. 33-43

« Back