Authors
Sannikov A.B.1, Emelyanenko V.M.1, Rachkov M.A.2, Drozdova I.V.3
1 Department of Further Professional Education of Healthcare Specialists, Russian National Research Medical University. N.I. Pirogov, Moscow–Vladimir
2 Department of Radiation Diagnostic Methods, First Clinical Medical Center, Kovrov, Vladimir region
3 Medical Center «Palette», Vladimir
Abstract
Since 2015, 400 persons of both sexes with chronic venous diseases have been examined using the developed method of MSCT-phlebography: C0-50 persons (12,5%), C1 – 58 persons (16,5%), C2-C3 – 173 patients (49,5%) and 119 persons (34%) had trophic disorders (C4-C6). The studies were carried out on a 128-slice multispiral computed tomograph Ingenuity CT by Philips with a software package for processing images with Intel Space Portal technology, with following reconstruction in the three-dimensional image (3D mode). In 400 studied limbs 5879 calf veins were identified, which were represented by single, doubled, V-shaped and Y-shaped trunks, having a mixed form in 96% of cases. The analysis of the obtained data allowed to distinguish the main veins of the 1st order, axial veins of the 2nd order and terminal veins of the 3rd order, which made up 16.6%, 36.8% and 46.6% of the total number of detected veins, respectively. Depending on the level of division of the main and axial veins and the degree of intensity of the presence of the terminal veins, the main, network and mixed type of development of the venous line were identified. The presence of the valve apparatus was found in 100% of cases at the level of the main veins of the 1st order and in 86% of observations at the level of the 2nd order veins. In the terminal veins of the 3rd order, the valve apparatus was poorly visualized. The vast majority of communication connections of calf veins with hypodermic lines occurred on the medial and posterior-medial surfaces of the leg, by means of perforants located here in 48% of observations with oblique vein, in 23% of intersaphenous and in 57% of cases with posterior arch vein, that is, belonged to the group of the medial head of the calf muscle (medial gastrocnemius perforators veins). In 15% of cases it was possible to identify the connection of calf veins of the 3rd order with the perforant «May» (intergemellar perforators veins). 82.3% of the veins of the calf muscle had a cylindrical form of structure, and 17,7% of cases were fusiform ectasia of these veins of various lengths.
Keywords: Gastrocnemius Muscle Veins, Calf veins, MSCT-phlebography, anatomical structure of lower extremity veins, sural veins, intramuscular veins, varicose veins, chronic venous diseases.
References
1. Vedenskij, A.N., Gricanov, A.I., Stojko,Yu.M. Venoznye sinusy kak glavnyj ehlement myshechno-venoznoj pompy goleni. Mezhdunarod. Med. Obzory. 1994; 2(1): 50–53.
2. Gavrilenko, A.V. Diagnostika i lechenie hronicheskoj venoznoj nedostatochnosti nizhnih konechnostej. Moskva, 1999.
3. Dumpe, E.P., Uhov, Yu.I., SHval’b, P.G. Fiziologiya i patologiya venoznogo krovobrashcheniya nizhnih konechnostej. M.:Medicina, 1982.
4. Konstantinova, G.D., Voskresenskij, P.K., Gordina, O.V. Praktikum po lecheniyu varikoznoj bolezni. M.: Profil’, 2006.
5. Konstantinova, G.D., Zubarev, A.R., Gradusov, E.G. Flebologiya. M.:Vidar, 2000.
6. Lazarenko, V.A., Sannikov, A.B. Rentgeno-anatomicheskie i funkcional’nye paralleli myshechnyh ven goleni v norme i patologii. Vizualizaciya v klinike. 2002; 21: 58–61.
7. Patent RF na izobretenie № 2638920/ 18.12.2017. Byul. №35. Sannikov AB. Sposob mul’tispiral’noj komp’yuternoj tomografii-flebografii nizhnih konechnostej pri varikoznoj bolezni ven. URL.
8. Postnova, N.A. Ul’trazvukovaya diagnostika zabolevanij ven nizhnih konechnostej. M.: OOO «Firma STROM»; 2011.
9. Savel’ev, V.S., Gologorskij, V.A., Kirienko, A.I. Flebologiya: Rukovodstvo dlya vrachej pod redakciej Savel’eva VS. M.:Medicina, 2001.
10. Stojko YUM, Lytkin MI, SHajdakov EV. Venoznaya gipertenziya v sisteme polyh ven. Sankt-Peterburg, 2002.
11. Cvibel’, V., Pellerito, Dzh. Ul’trazvukovoe issledovanie sosudov. Vidar M, 2008.
12. SHval’b, P.G., Kalinin, R.E., SHanaev, I.N., Puchkova, G.A., Suchkov, I.A. Topografoanatomicheskie osobennosti perforantnyh ven goleni. Flebologiya. 2015; 2: 18–24.
13. SHval’b, P.G., Uhov, Yu.I. Patologiya venoznogo vozvrata iz nizhnih konechnostej. Ryazan’, 2009.
14. SHevchenko, Yu.L., Stojko, Yu.M. Klinicheskaya flebologiya. Moskva.: «Press», 2016.
15. Shevchenko, Yu.L., Stojko, Yu.M., SHajdakov, E.V., Skrabovskij, V.I. Anatomo-fiziologicheskie osobennosti myshechno-venoznyh sinusov goleni. Angiologiya i sosudistaya hirurgiya. 2000; 6 (1): 57–60.
16. Aragao, J.A., Reis, F.P., Pitta, G.B.B., Miranda, F.Jr., Poli de Figueiredo L.F. Anatomical Study of the Gastrocnemius Venous Network and Proposal for a Classification of the Veins. Eur J Vasc Endovasc Surg. 2006; 31: 439–442.
17. Calota, F, Mogoanta, S, Intorcaciu, M. The venous system of the lower limbs. Rom J Morphol Embryol 2007; 48: 4: 355–360.
18. Cavezzi, A., Labropoulos, N., Partsch, H. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs – UIP consensus document. Part II. Anatomy Vasa 2007; 36: 1: 62–71.
19. Coulier, B. Hyperechogenicity of medial gastrocnemial veins during ultrasound scanning of the calf in sitting patients: a normal variant. Eur Radiol 2002; 12: 1843–1848.
20. Gillot, C. Anatomical atlas of the superficial venous networks of the lower limb. Edit Phlebolog Franc, 1998.
21. Juhan, C., Barthe´le´my, P., Alimi, Y., Di Mauro, P. Re´cidives apre`s chirurgie des veines jumelles [Recurrence following surgery of the gastrocnemius veins]. J Mal Vasc 1997; 22: 326–329.
22. Netter, F. Atlas of Human Anatomy. 7th Edition. ELSEVIER, 2018.
23. Uhl, J.F., Caggiati, A. Three-dimensional evaluation of the venous system in varicose limbs by multidetector spiral CT. In: Catalano C. Passariello, eds. Multidetector-Row CT Angiography. Springer Berlin Heidelberg; 2005: 199–206.
24. Uhl J.F., Gillot C. Anatomy of the foot venous pump: physiology and influence on chronic venous disease. Phlebology: The Journal of Venous Disease. 2012; 27(5): 219–230.
25. Uhl, J.F., Gillot, C., Verdeille, S., Martin-Bouyer, Y., Mugel, T. Trekhmernaya KT-flebografiya: perspektivnyj novyj metod issledovaniya venoznoj sistemy. Flebolimfologiya, 2003; 20: 12–16.
26. Uhl, J.F., Ordureau, S. New computer tools for virtual dissection to study the anatomy of the vascular system. Phlebolymphology. 2008; 15(4): 151–155.
27. Uhl, J.F, Verdeille, S., Martin-Bouyer, Y. Springer Verlag Ed Pavone, Debating Pre-operative assessment of varicose patients by veno-CT with 3D reconstruction. 3rd International workshop on multislice CT 3D imaging. 2003: 51–53.
28. Uhl, J.F, Verdeille, S., Martin-Bouyer, Y. Three-dimensional spiral CT venography for the preoperative assessment of varicose patients. Vasa. 2003; 32(2): 91–94.
29. Urigo F, Pischedda A, Mocci M, Carpanese L, Canalis GC. Incompetence of the m. gemellus veins in varicose veins: its incidence and phlebographic study. Radiol Med (Torino) 1992; 84: 48–53.
