[Functional assessment of the lymphatic bed of patients in the late clinical classes of chronic venous insufficiency according to the international GEAP classification].
The author revises the contents and limits of the anatomic CEAP classification. For this purpose 84 patients with different types of trophic disorders of the lower limbs were examined with the aid of the author's technique of functional lymphography and lymphoscintigraphy. Impairment of drainage and transport function of the lymphatic capillaries was established from the ulcer edge at the level of the outgoing (from skin to collector) and collecting (from foot to regional nodes) capillaries. A close relationship was discovered between secondary changes in the lymphatic bed and the severity of trophic disorders. In groups with dilated and stenosed vessels, there were subgroups of patients with preserved function of lympangions. The data obtained evidence that lymphovenous insufficiency beyond the area of trophic disorders is more pronounced than in the focus itself. This may play a decisive role in the choice of the treatment modality as dependent on the condition of the drainage pathways. To refine the diagnosis in patients showing disease progression, with failed treatment of trophic ulcers including ulcerous defects, the author suggests that A category may be divided into two subgroups: Av for characterization of different veins and Al for lymphatic vessels of varying levels: S (skin), (Tissue) and Lnd (lymph nodes). The use of additional criteria for the diagnosis substantially improves the characteristics of the international CAAP classification.
Department of Angiography and Roentgenosurgery, N.A.Semashko Central Clinical Hospital, RF Ministry of Railway Communications, Moscow, Russia.
G V
GV
Chepelenko
D003097:Collateral Circulation / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008220:Lymphography; D008297:Male; D011379:Prognosis; D011877:Radionuclide Imaging; D012720:Severity of Illness Index; D014689:Venous Insufficiency / Q000145:classification* / Q000503:physiopathology