Diagnostic Study Of Color Doppler Ultrasonography In Postthrombotic Syndrome

Postthrombotic Syndrome(PTS)is one of the most common lower limbs venous disease. There are much more patients come to doctors because of PTS than acte deep venous thrombosis(DVT).The main causes of PTS may be :①The patients didn't diagnose definitudely or treat effectively.②The patients gained right diagnoses and treated reasonable. But the effect is not distinct or the period of treatment hasn't been finished because of the poor economic conditions.③the patients come to hospital after be taken bad many months or many year ,because the disease is very obscurity .When the patients fall DVT, because of the above-mentioned, the thrombus leave in veins for a long time. The affected limbs become pigmentation, skin swelling, the temperature hoist, tenderness。The pain and swelling prick up after walking. Some patients have callosity subcutaneous and scarfskin ulceration. Postthrombotic Syndrome(PTS)influence activity of affected limbs even could cause bleeding, limbs ulceration and so on, infecting the patients'life quality.According to the studies at present, obstruction of vensos circumfluence or/and return flow of vein may cause hemodynamics'unconventionality in PTS. Deep venous thrombosis shaped cause damage of vein valves and endodermis cell, higher blood viscosity. The materiality component of blood could be aggradation, and bring about venous thrombosis another time. A series pathology changes could be appeared in veins and surrounding parenchyma.This paper use high frequency color Doppler ultrasound examined 60 cases PTS patients. Observed diameter of vein, smooth degree of wall, echo in the vein antrum, spectrum of thrombus, function of vein valve, color Doppler Flow Imaging, color Doppler ultrasound, Echo Curve of Doppler Flow velocity. It has important clinical significance.Use color Doppler ultrasound diagnose limbs'deep venous thrombosis is a good unwounded examine method. It is exact, reliable, easy, repeatedly, and has important clinical value.1 Materials and Methods1.1 Patients and MaterialsFrom June ,2006 to March,2007 ,60 patients in Post thromboticSyndrome(PTS)were diagnosed in our hospital. Observed 33 cases'diameter vessel, velum inner vein, compressibility of vein, echo in the vein antrum before and after treated. The diagnosed standard and clinical manifestations are both accord with Post thrombotic Syndrome(PTS)diagnosed standard which is castigated in the 4th national herbalist and Western medicine combined to cure circumference blood vessel disease learning conference in 1995.1.2 Examine Method:1.2.1 ApparatusUsing vivid7 color Doppler ultrasound Diagnostic machine with abdominal probe frequency12 MHz which produced by GE of the U.S.A.1.2.2 MethodsTold the patients in supine position, limbs revolve outer and relaxation. Examine affected limb's iliac vein, femoral vein, and later examine popliteal vein ,and veins between muscle when patient in prone position. Firstly, observe long-axis imagine in two-dimensional, measure diameter of vein, smooth degree of wall, compressibility of vein, echo in the vein antrum. Secondly,showsufficient degree in veins using color Doppler flow imagine. Lastly, examine the function of vein valve, measure regurgitation time in order to evaluate their regurgitation degree.1.2.3 Observed Content(1)Two-dimensional Imagine: Observed the part, range, echo of thrombus and vein's diameter, wall, compressibility of vein, the number of opened traffic vein .Pay attention to if the patients suffered superficial varicosity, veins between muscles expend, lymph dropsy or swelled lymphnode in groin.(2)Color Doppler Ultrasound Imagine: Observed the sign of blood flow and sufficient degree in veins in order to judge the style of reconnect of thrombus. Observe regurgitation range and so on.(3) Echo Curve of Doppler Flow Velocity: Observed the range of regurgitation, regurgitation time and speed of vein's valve, in order to estimate the degree of vein's valve.1.2.4 Date Stat. and AnalyseUsing X2 test to compare the two groups. There is a significant difference when P﹤0.05. There is a most significant difference when P﹤0.01.2 Results and Discussion2.1 Characteristic of Two-dimensional Imagine Because of dehydration, the bulk of thrombus shrink in period of sequela. The stiffened thrombus conglutinate to the wall of veins and become oranization. At the beginning of organization, granulation tissue which is containing capillary vessel, muscle fibronectin cells and tissue cells enter into thrombus, and lick up and dissolute the thrombus. The closed vein reconnect because the epithelioid cells covered and the capillary vessels in the thrombus connect with the blood vessel system. The below segment of superficial femoral vein(SFV) is hard to be observed by Two-dimensional ultrasound.It can't be distinguished from the vein's wall. Although the vein has reconnected ,the vein's valve distorted due to fibronation. The function destroyed seriously, the blood in veins flow backwards. The result is the great saphenous vein(GSV) become pathological changes.Observed 33 patients affected with Postthrombotic Syndrome(PTS), compared the items before and after treatment. And there are significant differences in several items, such as compressibilityof vein, velum of vein's wall, echo of vein and so on. The result shows that the vein's diameter, velum , compressibility ,and echo are all straightened up after the patients accepted treatment.2.2 Characteristic of Color Doppler Ultrasound ImagineGhyll shaped signal of blood flow would be showed by Color Doppler ultrasound when the thrombus in vein reconnected, especially in the border of the vein. The antrum of the vein could be full of signal of blood flow when the vein reconnected completed. The regurgitation time would be 1-2s when told the patients take Valsalva action. Most patients'damaged veins are from common femoral vein(CFV) to popliteal vein(POV),next are from external iliac vein(EIV) to popliteal vein(POV),external iliac vein(EIV) to superficial femoral vein(SFV), superficial femoral vein(SFV) to popliteal vein(POV),common iliac vein(CIV) to popliteal vein(POV),the least are the veins between muscles. The thrombus in the veins between muscles could get best effect after treated; in commom femoral vein(CFV) to popliteal vein(POV), external iliac vein(EIV) to superficial femoral vein(SFV), superficial femoral vein(SFV) to popliteal vein(POV), common iliac vein(CIV) topopliteal vein(POV) also could get good effect; in external iliac vein(EIV) to popliteal vein(POV) couldn't get perfect effect, and need a long period to treat.2.3 Echo Curve of Doppler Flow VelocityThe regurgitation time and speed of every vein are both the same approximately. There would be less clinical symptom when regurgitation occuered in the superficial femoral vein(SFV) than in the popliteal vein(POV).The clinical symptom of B group is much serious than A group.The occurent rate of regurgitation in the popliteal vein(POV) shows that there is consanguineous relativity between the ponderance of clinical symptom and whether the regurgitation in the popliteal vein(POV) occered. The superficial femoral vein(SFV) is the continuous branch of iliac vein and femoral vein in the vein system of limbs. The applied force to the superficial femoral vein(SFV) is biggest because of this vein is vertical columns downward. And the valve's abnormal function of deep veins is an important cause of superficial varicosity. So the disease of the great saphenous vein and valve's abnormal function of superficial femoralvein(SFV) are always concurrence.3 ConclusionThere is important clinical significance of analysis to the characteristic of two-dimensional imagine, Color Doppler ultrasound imagine, and echo curve of Doppler flow velocity in Postthrombotic Syndrome(PTS)patients. It is an important method to diagnose Postthrombotic Syndrome(PTS).It could be taken as effective foundation of the selection of operation and could appraise the curative effect about the operation. And this method has important clinical value in choosing better Rx in next period. Using Color Doppler ultrasound to diagnose Postthrombotic Syndrome(PTS) is a good unwounded examining method. It's exact, reliable, easy, repeatable method and having high clinical value. This research proved that Postthrombotic Syndrome(PTS)is a disease could be cured by logical treated and a period time to refresh. Using Color Doppler ultrasound to diagnose Postthrombotic Syndrome(PTS)has many merits such as unwounded, real time, dynamic, repeatable and so on. It could diagnose exactly to if the thrombus on the wall or velum of limb deep vein's , and could show the position and size ofthe thrombus .It could show sufficient degree in veins and function of vein's valve. This method offers impersonality foundations and has important significance in thrombus, the current estate of the limbs and how to treat this disease.In many medical treatment centers of blood vessel disease, CDFI has been the first choose in diagnosing PTS instead of DSA because it is unwounded , sensitivity and distinctive.