Ambulatory phlebectomy in patients with a factor V Leiden mutation

Česká verzia

Authors: M. A. Horáková ¹; V. Křížková ²; J. Kočová ²; E. Horáková ¹
Authors place of work: Flebologická soukromá ordinace, Praha Vedoucí: Dr. med. MUDr. Magdalena Anna Horáková ¹; Lékařská fakulta UK, Plzeň Ústav histologie a embryologie Vedoucí: doc. MUDr. Jitka Kočová, CSc. ²
Published in the journal: Prakt. Lék. 2009; 89(10): 545-551
Category: Reviews

Summary

The occurrence of sterile inflammation of both superficial and deep venous system and of embolism was evaluated in two groups of patients, which underwent an ambulatory phlebectomy of the saphenous complex. Histological examination was focused on the saphenous vein in thrombophilic patients.

In the first group (n=593), only half of the patients took sick leave. In this group, we observed a sterile inflammatory reaction in the inguinal area in 35 patients. These patients had no sickness leave, thus they were not able to follow an adequate treatment regimen.

In second group of patients (n=565), that all took sick leave, no complication occurred. As laboratory assessment of thrombophilia is not routinely performed and there is no difference in clinical symptoms of chronic venous insufficiency with or without thrombophilia, it is necessary to respect a two-week phase of healing accompanied with changes of blood acute protein levels. Thus, two weeks of sick leave following major saphenous complex resection is recommended. An ambulatory phlebectomy is a safe method even in thrombophilia, without risk of pulmonary embolism. There is no need of heparinization. Patients suffering from thrombophilia have more serious signs of vessel wall damage in comparison with others.

Key words:
ambulatory phlebectomy, thrombophilia.

Zdroje

1. Kvasnička, J. Trombofilie a trombotické stavy v klinické praxi. Praha: Grada Publishing, 2003.

2. Bobek, K., Čepelák, V. Tromboembolická nemoc žilního původu. Praha: Státní zdravotnické nakladatelství, 1959, s. 148.

3. Dortu, J. La crossectomie sus-fasciale: au cours de la phlébectomie ambulatoire du complexe saphénien interne à la cuisse. Phlébologie 1993, 46(1), p. 123-137.

4. Muller, R. Mise au point sur la phlébectomie ambulatoire selon Muller. Phlébologie 1996, 49(30), p. 335-344.

5. Lang, J., Wachsmuth, W. Bein und Statik. Berlin-Heidelberg-New York: Springer-Verlag, 1972; p. 109.

6. Potron, G., Trzeciak, M.C. Compte rendu de la réunion sur l’hémostase. Phlébologie 2005, 58(4), p. 373-383.

7. Hamel-Desnos, C., Ouvry, P., Nesnos, P. et al. Sclérothérapie et thrombophilie: Démarche pour un consensus dans la sclérothérapie chez les thrombophiles. Phlébologie 2003, 56(2), p. 165-169.

8. Vojáček, J., Malý, M. Arteriální a žilní trombóza v klinické praxi. Praha: Grada Publishing, 2004.

9. Azoulay, J.P., Franchitti, D.S., Vin, F. Accidents trombo-emboliques au décours de la sclérothérapie. Thrombophlie et sclérothérapie. Phlébologie 2000, 53(4), p. 442-467.

10. Hanss, M. Thrombophilie: Indications du bilan d’hémostase en 2004 et perspectives d’avenir. Phlébologie, 2004, 57(4), p. 403-407.

11. Kočova, J. Overall staining of connective tissue and the muscular layer of vessels. Folia Morphologica 1970, 3, p. 293-295.

13. Horáková, M.A., Kočová, J., Prokopová, V., Horáková, E. Étude comparative chez l´adulte de l´évolution des petite et grande saphènes à travers l´observation et l´analyse de la varicose de ces deux types de veines. Phlébologie 2000, 2, p. 147-153.

14. Horáková, M.A., Kočová, J., Křížková, V., Horáková, E. Histologie, structure de la paroi et évolution de l’anévrysme veineux de la grande veine saphène par rapport à celui de la petite saphène. Phlébologie 2002, 55(2), p. 139-147.

15. Golledghe, J., Quigley, F.G. Pathogenesis of varicose veine. Eur. J. Vasc. Endovasc. Surg. 2003, 25, p. 319-324.

16. Sansilvestri-Morel, P., Rupin, A., Badier-Commander, C. et al. Imbalance in the synthesis of collagen type I and collagen type III in smooth muscle cells derived from human varicose veins. J. Vasc. Res. 2001, 38, p. 560-568.

17. Prokopová-Křížková, V., Kočová, J., Horáková, M., Třeška, V. Struktura stěny normální a varikózní vény dolní končetiny. Praktická flebologie, 1998, 1, s. 34-36.

18. Badier-Commander, C., Couvelard, A., Henin, D. et al. Smooth muscle cell modulation and cytokine overproduction in varicose veins. An in situ study. J. Pathol. 2001, 193, p. 398-407.

19. Wali, M.A., Eid, R.A. Smooth muscle changes in varicose veins: an ultrastructural study. J. Smooth Muscle. Res. 2001, 37, p. 123-135.

20. Porto, L.C., Ferreira, M.A.P., Costa, A.M.A., da Silveira, P.R.M. Immunolabeling of type IV collagen, lamini and varicose saphenous veine. Angiology 1998, 49, p. 391-398.