畠山 卓弥 東京大学, 医学部附属病院, 助手 (60291324)
細井 温 東京大学, 医学部・附属病院, 助手
KOMIYAMA Takashi University of Tokyo, Surgery, Assistant, 医学部・附属病院, 助手 (10292947)
YASUHARA Hiroshi University of Tokyo, Surgery, Lecturer, 医学部・附属病院, 講師 (50251252)
SHIGEMATSU Hiroshi University of Tokyo, Surgery, Assistant Professor, 医学部・附属病院, 助教授 (40134556)
HOSOI Yutaka University of Tokyo, Surgery, Assistant
|Budget Amount *help
¥2,900,000 (Direct Cost : ¥2,900,000)
Fiscal Year 1998 : ¥500,000 (Direct Cost : ¥500,000)
Fiscal Year 1997 : ¥2,400,000 (Direct Cost : ¥2,400,000)
Patients with chronic venous insufficiency (CVI) were evaluated from the aspect of ambulatory venous function using near-infrared spectroscopy (NIRS). Patients with primary varicose veins and volunteers with normal limbs were studied. The affected limbs of the patients were divided into three groups according to their clinical signs and symptoms. All of the patients underwent a treadmill walking test, during which NIRS was applied. Oxygenated hemoglobin (OxyHb) and deoxygenated hemoglobin (DeoHb) were continuously measured by NIRS during exercise. The ambulatory venous retention index (AVRI) obtained from serial changes in DeoHb was assessed comparatively in the four groups (normal and mild to severe CVI). Two distinct patterns of DeoHb change were observed. During exercise, the DeoHb level decreased in the normal group due to calf muscle contraction, whereas, in the varicose group, . the DeoHb level rose because of an apparent venous reflux into the calf muscles. AVRI studies demonstr
ated a significant difference (p<O.OOOl) among groups. NIRS is useful for accurately assessing ambulatory venous dysfunction in patients with primary varicose veins.
To determine the influence of the site affected by thrombi on the subsequent venous physiology, we examined patients with post-thrombotic syndrome (PTS) with respect to ambulatory venous function using NIRS.Patients, in whom more than one year had passed since an acute episode of deep vein thrombosis (DVT), were studied. The mean duration of PTS was 8.2 years. All of the patients underwent a treadmill walking lest with simultaneous NIRS.DeoHb was continuously measured during exercise. The AVRI obtained from the serial DeoHb changes was calculated in each patient. The location of thrombi at the onset of DVT was identified by venography. The calculated AVRI was apparently related to the clinical symptoms of PTS.The limbs initially involved with popliteal vein thrombosis showed significantly higher AVRI values than those without popliteal vein thrombosis. The clinical severity of PTS is correlated well with the degree of venous retention during exercise. Initial involvement of the popliteal vein is an important factor determining subsequent venous hemodynamics in patients with PTS.
To investigate the diagnostic value of NIRS for the detection of DVT, particularly isolated calf DVT, in comparison with air plethysmography (APG), patients with clinically suspected DVT were studied. All patients were examined by venography and APG.Patients also underwent a treadmill-walking test with simultaneous NIRS.The AVRI obtained from serial DeoHb changes was calculated in each patient. Tue overall sensitivity of NIRS and APG was 97% and 80%0, respectively. NIRS was more sensitive than APG for detecting isolated calf DVT (89% and 22%, respectively), while both tests identified proximal DVT in all limbs. NIRS is a highly sensitive method for the diagnosis of hemodynamically significant DVT.
2, Postthrombotic syndrome(PTS)症例における静脈還流機能評価