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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3829_Библиотеки_им_академика_М_И_Перельмана
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Michael H. Criqui
https://t.me/med1917
University of California, SanDiego
La Jolla,CA
Linda M. Graham
Cleveland Clinic Lerner Research Institute
Cleveland,OH
Michael C. Dalsing
Indiana University School of Medicine
Indianapolis,IN
Alun H. Davies
Charing Cross Hospital
London, United Kingdom
Meryl Davis
Charing Cross Hospital
London, United Kingdom
M a r i a n n e D e M a e s e n e e r
University Hospital of Antwerp
Edegem, Belgium
Julie O. Denenberg
University of California, SanDiego
La Jolla ,CA
J o s e A . D i a z
School of Medicine, University of Michigan
Ann Arbor,MI
Wa l t e r N . D u r a n
New Jersey MedicalSchool
Newark,NJ
Bo Eklöf
Doctors O ceCenter
Helsingborg,Sweden
David A. Frankel
Scripps HealthcareSystem
La Jolla,CA
Arnost Fronek
University of California, SanDiego
La Jolla,CA
Steven S. Gale
Jobst VascularCenter
e Toledo Hospital
Toledo,OH
J e a n - J é r ô m e G u e x
PhlebologyClinic
Nice,France
J o h n A . He i t
MayoClinic
Rochester,MN
R u s s e l l D . Hu l l
Foothills Hospital
Calgary, Alberta,Canada
Marcello Izzo
University of Ferrara
Ferrara,Italy
Colleen M. Johnson
Division of Vascular Surgery
Southern Illinois University School of Medicine
Spring eld,IL
D a m i e n J o l l e y
Monash University
Victoria, Australia
Manju Kalra
MayoClinic
Rochester,MN
N i k h i l K a n s a l
Steward Health CareSystem
Brighton,MA
R o b e r t M . K a p l a n
UCLA School of PublicHealth
Los Angeles,CA
Robert L. Kistner
Kistner VeinClinic
Honolulu,HI
BrajeshK. Lal
University of Maryland Medical Center(UMMC)
Baltimore,MD
P e t e r G l o v i c z k i
MayoClinic
Rochester,MN
R o b e r t D . L a n g e r
Jackson Hole Center for Preventive Medicine
Jackson,WY
x • CONTRIBUTING AUTHORLIST
James Laredo
https://t.me/med1917
George Washington University School of Medicine
Washington,D.C.
Geza Mozes
MayoClinic
Rochester,MN
Byung-Boong (B.B.) Lee
George Washington University School of Medicine
Washington,DC
A n d r e w L i
University of California, San Diego School of Medicine
San Diego,CA
T i m o t h y K . L i e m
Oregon Health & Science University
Portland,OR
T. Locret
Riviera Vein Institute
Nice,France
Nicole Loerzel
La Jolla VeinCare
La Jolla,CA
Joann M. Lohr
Lohr Surgical Specialists
Cincinnati,OH
D a n i e l D . M y e r s J r .
University of Michigan School of Medicine
Ann Arbor,MI
Kenneth Myers
Epworth Hospital
Richmond, Australia
F r a n c i s c o J. O s s e
Vein Center of SaoPaulo
Sao Paulo,Brazil
Frank T. Padberg Jr.
New Jersey MedicalSchool
Newark,NJ
Peter J. Pappas
New Jersey MedicalSchool
Newark,NJ
H u g o P a r t s c h
University ofVienna
Vienna, Austria
Fedor Lurie
Kistner VeinClinic
Honolulu,HI
Oscar Maleti
Hesperia HospitalModena
Modena,Italy
W i l l i a m M a r s t o n
University of North Carolina, ChapelHill
Chapel Hill,NC
Elna Masuda
Straub Clinic & Hospital
Honolulu,HI
J o h n C . M c C a l l u m
University of California, San Diego HealthSystem
San Diego,CA
Robert B. McLa erty
Southern Illinois University School of Medicine
Spring eld,IL
L u i g i P a s c a r e l l a
Duke University MedicalCenter
Durham,NC
M i c h e l P e r r i n
Clinique du GrandeLarge
Chassieu,France
Graham F. Pineo
Foothills Hospital
Calgary, Alberta,Canada
P a u l P i t t a l u g a
Riviera Vein Institute
Nice,France
Alessandra Puggioni
Scottsdale Vascular Services
Scottsdale,AZ
J o s e p h D . R a etto
VA Boston HealthcareSystem
Boston,MA
N i c k M o r r i s o n
Morrison Vein Institute
Scottsdale,AZ
J e rey K. Raines
Miami VeinCenter
Miami,FL
CONTRIBUTING AUTHORLIST • xi
S e s h a d r i R a j u
https://t.me/med1917
e RANE Center for Venous and Lymphatic Diseases
River Oaks Hospital
Jackson,MS
Albert-Adrien Ramelet
Lausanne, Switzerland
Philip Coleridge Smith
British Vein Institute
London, United Kingdom
L i a n S o r h a i n d o
Weill Cornell Medical College of Cornell University
NewYork,NY
Virginia Ratcli
La Jolla VeinCare
La Jolla,CA
Pritham P. Reddy
Southern Illinois University School of Medicine
Spring eld,IL
G r a e m e D . R i c h a r d s o n
Rural ClinicalSchool
Wagga Wagga, Australia
Stefania Roberts
Victoria VeinClinic
East Melbourne, Australia
Maria V. Rubia
Instituto Internacional de Flebologia
Barcelona,Spain
Teresa Russell
VA San Diego HealthcareSystem
La Jolla,CA
Robert B. Rutherford
e University of Colorado Medical Center
Corpus Christi,TX
N e i l S a d i c k
Sadick Dermatology
NewYork,NY
Richard J. Sanders
Denver Vascular Surgical Associates
Denver,CO
J o c e l y n A . S e g a l l
Oregon Health & Science University
Portland,OR
Patrick A. Stone
CAMC Health Systems
Charleston,WV
P a u l K . ibault
Central Vein & Cosmetic MedicalCentre
Broadmeadow, Australia
Patricia E. orpe
University of Arizona MedicalCenter
Arizona Heart Hospital
Phoenix,AZ
omas W. Wake eld
University of Michigan School of Medicine
Ann Arbor,MI
eodore E. Warkentin
McMaster University
Hamilton General Hospital
Hamilton, Ontario,Canada
Margaret A. Weiss
Johns Hopkins School of Medicine
Baltimore,MD
R o b e r t A . We i s s
Johns Hopkins School of Medicine
Baltimore,MD
R o b e r t W . Z i c k l e r
New Jersey MedicalSchool
Newark,NJ
Steven E. Zimmet
Zimmet Vein and DermatologyClinic
A u s t i n , T X
A . C . S h e p h e r d
Charing Cross Hospital
London, United Kingdom
xii • CONTRIBUTING AUTHORLIST
P A R T I
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BASIC CONSIDERATIONS
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1 .
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HISTORICAL INTRODUCTION
Alberto Caggiati and Claudio Allegra
n 1628, William Harvey explained in his De Motu
Cordis the theory of the blood circulation (see
I
Figure1.1). However, the discovery of the circulation
was not complete until 1661, when Marcello Malpighi in
his De Pulmonibus demonstrated by microscopy the exis-
tence of the capillaries (see Figure1.2).
e heart has been regarded as the center of the vascular system (Empedocles of Agrigentum; 500–430 ) since
the h century . e great epic of India, Mahabharata ,
stated that “all veins proceed from the heart, upwards,
downwards and sideways and convey the essences of food to
all parts of the body.” e Chinese Wang Shu Ho reported
in his Mei ching that “the heart regulates all the blood in the
body . . . e blood current ows continuously in a circle and
never stops.” Herasistratus (310–250 ) was so close to the
discovery of the circulation as to guess the existence of capillaries:“the blood passes from the veins into arteries thorough ‘anastomoses,’ small inter-communicating vessels.”
ese correct theories were darkened by Hippocratic
dogma for centuries. Hippocrates of Cos, the “father of
Medicine” (460–377 ) a rmed in De Nutritione that the
liver is the “root” of all veins, that the veins alone contain
blood destined for the body’s nourishment, and that arteries
contain an elastic ethereal uid, the “spirit of life.” is incorrect theory, based on the Pythagorean doctrine of the four
humors (blood, phlegm, yellow bile, and black bile), remained
the basis for medical practice for more than 2000years.
Beginning in the fourteenth century, many authors confuted the Hippocratic theory, allowing, and sometimes anticipating, Harvey’s discovery; but more than three centuries
(1316–1661) passed before it was abolished. In 1316, Mondino
de Luzzi furnished a rudimental but exact description of the
circulatory system that was omitted by all subsequent authors:
Postea vero versus pulmonem est aliud ori cium
venae arterialis, quae portat sanguinem ad pul-
monem a corde; quia cum pulmo deserviat cordi
secundum modum dictum, ut ei recompenset, cor ei
transmittit sanguinem per hanc venam, quae vocatur
vena arterialis; est vena, quia portat sanguinem, et
arterialis, quia habet duas tunicas; et habet duas
tunicas, primo quia vadit ad membrum quod existit
in continuo motu, et secundo quia portat sanguinem valde subtilem et cholericum.
e same occurred to the Spanish Ludovicus Vassaeus
and Michael Servetus. e anatomy of the cardiovascular system was so well depicted by Vassaeus ( De Anatomen Corporis
Humani Tabulae uator , 1544) that Marie Jean Pierre
Florens a rmed that he “described the blood circulation a
century before William Harvey.” In 1546, the anti-Arabist
theologician and physician Servetus exactly described the
pulmonary circulation: “the blood enters the lungs by the
way of the pulmonary artery in greater quantities than necessary for their nutrition, mixes with the pneuma and returns
by way the pulmonary veins.” Servetus’s discovery did not
di use among contemporary physicians, probably because it
was reported in a theological book. Servetus’s theories were
so innovative that he was accused of heresy by Calvinists
and burned. Andrea Cesalpino, professor of medicine at
Rome, rst identi ed the function of the valves (“certain
membranes placed at the openings of the vessels prevent the
blood from returning”) and the centripetal direction of the
ow in the veins (1571). He also supposed the existence of
“ vasa in capillamenta resoluta ” (capillaries) and a rmed that
in the lung the blood “is distributed into ne branches and
comes in contact with the air” (1583). Finally, he coined the
term “circulation.” According to important historians like
Florens, Richet, and Castiglioni, Cesalpino did the groundwork for Harvey’s revelation.
V E N O U S A N A T O M Y
e rst systematic description of the venous system was
given by André Vesale (alias Vesalius) in De Humanis
Corporis Fabrica (1543). Vesalius’s venous anatomy was
almost complete (see Figure1.3) though it contained some
3
A
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B
Figure1.1 ( A) e famous illustration used by Harvey in his De Motu
Cordis (1661) showing the direction of ow into the veins and
(B)the plate published sixty years before by Hyeronimus Fabricius of
Acquapendente (1603).
Figure1.2 e original Malpighi’s representation of the lung capillary bed
( DePulmonibus ,1661).
Figure1.3 e venous system according to Vesalius (1545).
omissions, such as venous valves and perforating veins.
Vesalius furnished a good description of the structure of the
venous wall. He di erentiated the internal coat of the veins
in two layers. e internal one contained contractile bers,
though “dissimilar from those of skeletal muscles, arranged,
from within outwards, circularly, obliquely and longitudinally.” e outer coat was formed by a loose network borrowed from surrounding structures.
VESALIUS’S OMISSION I:
VENOUSVALVES
Giovanni Battista Canano from Ferrara, was the rst to
describe venous valves in 1540 (“ ostiola sive opercula ”), in the
renal, azygos, and external iliac veins. According to Franck
Cockett, “he identi ed correctly the function of the valves,
i.e., to avoid blood re ux.” Further sporadic descriptions of
venous valves were given by the Spanish anatomist Vassaeus
(1544) and, one year later, by Charles Estienne (“ apophyses
membranarum ”). Valves in the veins of the lower limbs rst
were reported by Sylvius Ambianus in 1555, and their rst
illustrations appeared in the Salomon Alberti’s De valvulis
membraneis vasorum (1585). Finally, Hyeronimus Fabricius
of Acquapendente published in 1603 an exhaustive description of the valves of the veins with magni cent gures (see
Figure1.4) that were used by his pupil Harvey to demonstrate the direction of ow (see Figure1.1). Four centuries
4 • BASIC CONSIDERATIONS
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Figure1.4 e saphenofemoral junction according to Fabricius (1603).
passed before it was demonstrated that venous valves not
only steer blood return and prevent re ux but also, accord-
1
ing to Lurie etal, modulate venous ow.
VESALIUS’S OMISSION II:
PERFORATINGVEINS
e second gap in Vesalius’s venous anatomy was lled at
the beginning of the nineteenth century (1803), when the
anatomist Justus Christian Von Loder represented exactly
the more important perforating veins of the human body
(see Figure1.5). Von Loder omitted a description of their
function; that was clari ed only in 1855, when Aristide
August Verneuil described the presence of valves within
perforating veins and the direction of blood o w i n t h e m .
T H E R E T U R N O F T H E
VENOUSBLOOD
Figure1.5 e rst representation of perforating veins in Von Loder’s
Anatomische Tafeln (1803).
muscular pumping. Antonio Valsalva, pupil of Malpighi,
described in 1710 the aspiratory forces that enhance venous
return to the heart:the “ vis a onte ” due to the rhythmic
respiratory changes of thoracoabdominal pressure. In 1728,
Giovanni Lancisi demonstrated experimentally the spontaneous rhythmical contraction of larger veins. Finally, John
Hunter suggested in 1793 that the pulsation of arteries assists
the blood return in certain veins. J.F. Palmer, the editor of
the posthumous Hunterian Of the Vascular System (1837),
added a footnote:“especially when a common sheath exists.”
ETIOLOGY AND PATHOGENESIS
OF VARICOSEVEINS
Hippocrates was the rst to deal with the pathogenesis and
epidemiology of varicose disease when he a rmed that
Table1.1 MECHANISMS OF VENOUS PROPULSION
e mechanisms allowing blood to ow centripetally along
the veins were described more than two hundreds years ago
(see Table1.1). e “ vis a tergo ” was described in 1670 by
Richard Lower:“the return of the venous blood is the result
of the impulse given to the arterial blood.” Furthermore,
Lower acknowledged an important role to the “ venarum
tono ” in venous return, and described the e ects of the
1670 Richard Lower Propulsive vis a tergo
1670 Richard Lower Muscle pump
1670 Richard Lower Tone of the venous wall
1710 Antonio Valsalva Aspirative vis a onte
1728 Giovanni Lancisi Contraction of the venous wall
1793 John Hunter Pulsation of neighboring arteries
HISTORICAL INTRODUCTION • 5
varicose veins were more frequent in Scythians because of
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the prolonged time spent on the horseback with the legs
hanging down. In 1514, Marianus Sanctus noted that varicose veins were more frequent a er pregnancy and in people
who stood for long periods of time (“standing too much
before kings”). In 1545, Ambroise Paré related varicose veins
to pregnancy and long traveling and a rmed that they are
more frequent in melancholic subjects. Ten years later, Jean
Fernel (1554), professor of medicine at Paris, stated that
varicose veins can develop a er an e ort or a trauma:“the
varix comes also from a blow, from a contusion, from an
e ort.” Rudolf Virchow (1846) was the rst to point out
the hereditary tendency to varicose veins. Finally, the rare
syndrome due to congenital absence of venous valves was
rst reported by Josephus Luke in1941.
e rst to attribute the onset of varicose veins to valvular
incompetence was Hyeronimus Fabricius (1603). e parietal theory rst was promulgated by Richard Lower, who in
1670 a rmed that a “ relaxatio venarum tono ” (wall muscu-
lar looseness) is the cause of venous stasis and dilation. Pierre
Dionis credited in 1707 an important role to mechanical
compression of large trunks in the development of varicose
veins, whereas Jean Louis Petit (1774), the eminent French
surgeon, reported their possible occurrence during obstruction of proximal veins. According to these two authors, the
clinical syndromes due to compression of the le common
iliac vein were described by the Canadian James McMurrich
in 1906, and of the popliteal vein by Norman Rich and Carl
Hughes in 1967. Al Sadr described in 1950 the compression
of the le renal vein by the aorta and the superior mesenteric
artery. Paul Briquet was the rst to a rm in 1824 that varicose
veins are due to abnormal ow coming from deep veins via
the perforators. In 1944, E Malan described the occurrence of
varicose veins in limbs with abnormal arteriovenous connections. e theory of a subclinical parietal phlogosis inducing
venous valve disruption has been proposed only recently by
2
Takashi Ono, John J. Bergan, Geert Schmid-Schonbein.
of the endothelial lining. Only one century later (1946),
MacFarlane and Biggs described the “cascade” mechanism
for coagulation.
e “white swelling” of the lower limb or phlegmasia
alba dolens was accounted for by Charles White in 1784.
In 1857, Jean Baptiste Cruveilhier described the “ phlébite
bleue ” ( phlegmasia coerulea dolens ) and a rmed it is due to
the thrombosis of all the veins with patency of the arteries
(see Figures1.6 and 1.7). Sir James Paget investigated the
pathogenesis of phlebitis and described in 1866 a great
number of possible causes: traumatic phlebitis; distension phlebitis; phlebitis occurring in exhaustion or during
either acute or chronic disease; phlebitis due to extension
of in ammation from an ulcer; idiopathic, puerperal, and
pyemial phlebitis; and nally, phlebitis occurring in varicose
limbs. A clear nosologic discrimination between phlebothrombosis and thrombophlebitis was nally indicated by
Ochsner and De Bakey in 1939. e possible occurrence of
venous thrombosis of the leg due to prolonged sitting was
rst described by John Homans (1954). Incorrectly, the
association of prolonged sitting and venous thrombosis was
then limited to air travel and assumed the name “Economy
Class Syndrome.”
VENOUS THROMBOSIS
In 1544, the Spanish anatomist Vassaeus rst identi ed
the “vascular dessication” described by Hippocratic medicine with the phenomena of “coagulation,” that is, loss
of the liquid state of the blood. One year later, Paré rst
described super cial phlebitis (“a swollen vein, with jelly
blood, spontaneously painful”). In 1793, John Hunter
introduced the term “phlebothrombosis” and a rmed that
in ammation of the venous wall is always accompanied by
the formation of a clot. Matthew Baillie (1793), in contrast to Hunter, considered ow deceleration the cause of
thrombosis. Virchow, the greatest pathologist of all time,
de ned in 1846 the famous triad of conditions essential for
development of thrombosis:slowing of ow or its cessation,
excess of circulating thrombogenic factors, and disruption
Figure1.6 Ileocaval thrombosis (Cruveilhier,1857).
6 • BASIC CONSIDERATIONS
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Figure1.7 Postthrombotic varicose veins (Cruveilhier,1857).
Lipiodol. In 1929, McPheeters and Rice performed the
rst dynamic varicography and described the movement
of blood in the varicose veins. Further developments were
due to Ratschow (who in 1930 introduced water soluble
contrast media for angiography), Dos Santos (who demonstrated in 1938 the utility of direct ascending contrast
venography to detect deep venous thrombosis, or DVT),
and Farinas (who performed the rst pelvic venography
in 1947). Intraosseus phlebography was then proposed by
Schobinger in 1960 and re ned by Lea omas in 1970.
Finally, Dow described in 1973 the technique to perform
retrograde phlebography.
Traditional venography is even less used in daily practice
due to the achievement of duplex sonography. However,
radiologic venous imaging recently improved due to the
introduction of computed tomography (CT) and magnetic resonance (MR) techniques. CT was introduced
in 1980 to demonstrate venous thrombosis by Zerhouni.
Multislice CT, proposed rst in 1994 by Stehling to evaluate the venous bed of the lower limb, also is indicated for
the contemporary evaluation of the pulmonary vessels.
More recently, multislice CT has been proposed to obtain
3
3D images (see Figure1.8) of super cial veins
with special
reference to the preoperative evaluation of varicose limbs.
MR was introduced in the eld of the diagnosis of DVT
in 1986 by Erdman. MR venous imaging improved a er
2001, when the group of Jorge Debatin proposed the technique called “low-dose, direct-contrast-injection 3D MR
5
venography.”
4
DIAGNOSIS OF VENOUS
DISORDERS
C L I N I C A L S E M I O T I C S
Clinical semiotics started in 1806, when the Swiss surgeon
Tommaso Rima described a simple test for the diagnosis of
saphenous re ux. In 1846, Sir Benjamin Brodie described a
method of testing for incompetent valves by constriction of
the limb and palpation. ese two tests were reproposed by
Friedrich Trendelenburg in 1890. In 1896, Georg Perthes
of Bonn described the famous test to verify the patency of
the deep veins. Finally, in 1938, John Homans described a
test for detection of deep venous obstruction based on foot
dorsi exion. Surprisingly, these tests and maneuvers still
appear in modern texts of vascular medicine and venous
surgery.
PHLEBOGRAPHY
e history of phlebography started in 1923, when
Berberich and Hirsch described the technique to demonstrate the venous system in living humans by infusion of
strontium bromide. One year later, Sicard and Forestier
performed the rst phlebography in humans using
Figure1.8 e rst contrastless 3D venography by multislice CT
(Caggiati,1999).
HISTORICAL INTRODUCTION • 7
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