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Arteriovenous shunting in varicose veins

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1 Arteriovenous shunting in varicose veins
Henry Haimovici, M.D.  Journal of Vascular Surgery  Volume 2, Issue 5, Pages (September 1985) DOI: / (85) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

2 Fig. 1 Venous flow tracings in varicose veins associated with postphlebitic syndrome of right leg in 55-year-old man. A and B tracings were taken 3 weeks apart. Note that degree of venous pulsatile flow varies with input of Doppler: Input I—amplitude of pulse wave is very low; Input II—it increases almost twice; Input III—it becomes three to four times greater. All tracings were obtained at site of healing ulcer of right ankle above medial malleolus away from posterior tibial artery location. Journal of Vascular Surgery 1985 2, DOI: ( / (85) ) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

3 Fig. 2 Venous flow tracings in recurrent varicose veins with 30-year history in 65-year-old woman associated with healed ulceration of left ankle and chronic dependency-induced edema. Normal dorsalis pedis arterial tracing (a); pulsatile venous tracing in area above ankle at site of previous ulceration (b); pulsatile venous tracings on medial side of and around knee area (c) and (d). Note difference in dorsalis pedis pulse wave characteristics from those in venous tracings. Journal of Vascular Surgery 1985 2, DOI: ( / (85) ) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

4 Fig. 3 Venous flow tracings in varicose veins in right leg of 60-year-old woman. A, Tracing of pulsatile venous flow from medial aspect of right ankle at site of spiderweb type varicosities (telangiectatic appearance). B, Arterial posterior tibial pulse tracing of same ankle. Note marked difference between characteristics of two pulse waves. Journal of Vascular Surgery 1985 2, DOI: ( / (85) ) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

5 Fig. 4 Venous flow tracings in 57-year-old man with massive varicose veins in left lower third of leg and ankle. A, Pulsatile venous flow obtained with leg in supine position above ankle ulcer and slightly anterior to medial malleolus. B, With leg in dependent position, amplitude of pulsatile wave is four times greater than that in supine position. Journal of Vascular Surgery 1985 2, DOI: ( / (85) ) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

6 Fig. 5 Venous pulsatile tracings obtained on lateral aspect of left leg in 87-year-old woman with recurrent ankle ulceration associated with varicose veins. Tracings (a) and (b) obtained on lateral aspect of upper third of leg in areas of increased skin temperature (“hot spots”); tracing (c) obtained above lateral malleolus at site of ulcer area. These tracings were recorded with leg dependent. Journal of Vascular Surgery 1985 2, DOI: ( / (85) ) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

7 Fig. 6 Serial femoral arteriogram of 47-year-old woman with primary varicose veins of both greater and lesser saphenous systems. Note within 2 seconds complete arterial visualization of foot. At 5 seconds only venous phase is visible. At 8 seconds, plantar venous opacification is increasing as is proximal venous tree. (From Haimovici H. Abnormal arteriovenous shunts associated with chronic venous insufficiency. J Cardiovasc Surg 1976;17: ) Journal of Vascular Surgery 1985 2, DOI: ( / (85) ) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions


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