Abstract
The presence of arteriovenous communications (AVCs) in the lower extremi ties of patients with primary varicose veins with or without ulcerations was inves tigated by use of thermography, analysis of the blood oxygen tension, and observation under operative microscopy.
Fifty-six subjects, including 20 normal subjects and 26 patients with primary varicose veins, were studied. Subjects maintained a standing position in a quiet room while thermography was performed both before and after exercise. The exercise was performed tiptoeing at a rate of twenty times per minute. After exer cise, hot spots on the lower extremities of the patients with varicose veins were localized by thermography. In the normal subjects, blood samples were aspi rated percutaneously from the femoral artery and vein before and after lumbar anesthesia. In the patients with primary varicose veins, an incision was made in the inguinal region following lumbar anesthesia and samples of blood were aspirated from the femoral artery and vein, the saphenous vein, and the ther mographic hot spots. The venous and arterial blood oxygen tensions were deter mined immediately in the hospital laboratory by means of a blood gas analyzer.
After lumbar anesthesia, there were significant differences between the oxy gen tensions of the hot spots and those of the femoral or saphenous veins in the patients with varicose veins (p < 0.01, p < 0.05). At operation, the hot spots were investigated by operative dissection and microscopy. Small, pulsating arteries were observed at the sites that corresponded to the hot spots. These results strongly suggest that AVCs open up in the dermal capillary bed as the result of a persis tently high venous pressure, and these shunts, by diverting oxygenated blood away from the overlying skin, produce skin ischemia and ulceration.
Get full access to this article
View all access options for this article.