correlation between venous insufficiency and valve function in deep vein thrombosis

应用近红外光谱（NIRS）从动态静脉功能方面对慢性静脉功能不全（CVI）患者进行评价。研究对象为原发性静脉曲张患者和肢体正常的志愿者。根据患者的临床体征和症状将患肢分为三组。所有患者都进行了跑步机行走测试，在此期间应用了近红外光谱。在运动过程中，用近红外光谱连续测量氧合血红蛋白（OxyHb）和脱氧血红蛋白（DeoHb）。比较四组（正常组和轻至重度CVI组）DeoHb系列变化获得的动态静脉潴留指数（AVRI）。观察到DeoHb变化的两种不同模式。在运动过程中，由于小腿肌肉收缩，正常组DeoHb水平下降，而在静脉曲张组，DeoHb水平下降。DeoHb水平升高是因为明显的静脉回流到小腿肌肉。AVRI研究表明，组间差异有统计学意义（p< 0.01）。近红外光谱可用于准确评估原发性静脉曲张患者的动态静脉功能障碍。为了确定受血栓影响的部位对随后静脉生理学的影响，我们使用近红外光谱（NIRS）检查了血栓后综合征（PTS）患者的动态静脉功能。研究了急性深静脉血栓（DVT）发作超过一年的患者。PTS的平均持续时间为8.2年。所有患者都进行了跑步机步行，以避免同时进行近红外光谱。在运动过程中连续测量DeoHb。计算每位患者DeoHb序列变化获得的AVRI。血栓在深静脉血栓形成时的位置通过静脉造影确定。AVRI计算值与PTS临床症状有明显相关性。初步腘静脉血栓形成的肢体AVRI值明显高于无腘静脉血栓形成的肢体。PTS的临床严重程度与运动时静脉潴留程度有良好的相关性。腘静脉的初始受累是决定PTS患者后续静脉血流动力学的重要因素。为了探讨近红外光谱（NIRS）对深静脉血栓（DVT）的诊断价值，特别是与空气容积描画（APG）进行比较，研究临床疑似深静脉血栓的患者。所有患者均行静脉造影和APG检查。患者还接受了同时进行近红外光谱的跑步机行走测试。计算每位患者连续DeoHb变化获得的AVRI。NIRS和APG的总灵敏度分别为97%和80%。近红外光谱（NIRS）在检测孤立的小腿DVT方面比APG更敏感（分别为89%和22%），而两种测试都能识别所有肢体的近端DVT。近红外光谱（NIRS）是诊断血流动力学意义显著的深静脉血栓的一种高度敏感的方法。少

Patients with chronic venous insufficiency (CVI) were evaluated from the aspect of ambulatory venous function using near-infrared spectroscopy (NIRS). Patients with primary varicose veins and volunteers with normal limbs were studied. The affected limbs of the patients were divided into three groups according to their clinical signs and symptoms. All of the patients underwent a treadmill walking test, during which NIRS was applied. Oxygenated hemoglobin (OxyHb) and deoxygenated hemoglobin (DeoHb) were continuously measured by NIRS during exercise. The ambulatory venous retention index (AVRI) obtained from serial changes in DeoHb was assessed comparatively in the four groups (normal and mild to severe CVI). Two distinct patterns of DeoHb change were observed. During exercise, the DeoHb level decreased in the normal group due to calf muscle contraction, whereas, in the varicose group, . the DeoHb level rose because of an apparent venous reflux into the calf muscles. AVRI studies demonstr … More ated a significant difference (p<O.OOOl) among groups. NIRS is useful for accurately assessing ambulatory venous dysfunction in patients with primary varicose veins.To determine the influence of the site affected by thrombi on the subsequent venous physiology, we examined patients with post-thrombotic syndrome (PTS) with respect to ambulatory venous function using NIRS.Patients, in whom more than one year had passed since an acute episode of deep vein thrombosis (DVT), were studied. The mean duration of PTS was 8.2 years. All of the patients underwent a treadmill walking lest with simultaneous NIRS.DeoHb was continuously measured during exercise. The AVRI obtained from the serial DeoHb changes was calculated in each patient. The location of thrombi at the onset of DVT was identified by venography. The calculated AVRI was apparently related to the clinical symptoms of PTS.The limbs initially involved with popliteal vein thrombosis showed significantly higher AVRI values than those without popliteal vein thrombosis. The clinical severity of PTS is correlated well with the degree of venous retention during exercise. Initial involvement of the popliteal vein is an important factor determining subsequent venous hemodynamics in patients with PTS.To investigate the diagnostic value of NIRS for the detection of DVT, particularly isolated calf DVT, in comparison with air plethysmography (APG), patients with clinically suspected DVT were studied. All patients were examined by venography and APG.Patients also underwent a treadmill-walking test with simultaneous NIRS.The AVRI obtained from serial DeoHb changes was calculated in each patient. Tue overall sensitivity of NIRS and APG was 97% and 80%0, respectively. NIRS was more sensitive than APG for detecting isolated calf DVT (89% and 22%, respectively), while both tests identified proximal DVT in all limbs. NIRS is a highly sensitive method for the diagnosis of hemodynamically significant DVT. Less