Monday, 27 April 2009 07:46
Export PDF
Print 
The diagnostic phlebological workup allows you, if necessary, to perform an high resolution projection of Eco-color Power Doppler (a) images with a HD (c) projector, using an image processing eco-graphic tube, so to open the possibility of a three-dimensional study of the veins with trans-luminescence or of the deep veins with a vein viewers ( VeinViewer).
The study and the diagnosis of the venous disease are performed in 3D, by Veinlite 150 or, when a more superficiality is required during the veins location, by Led Veinlite. It works with a halogen light, projected with fiber optics on a focal angle so to allow a good visualization of the refluxes of the incontinent superficial veins (because the light, projected on the skin, is absorbed by the hemoglobin stasis and then by the Iron, contained in red blood cells of pathological reflux). It also allows visualization adjustments of the light between minimum and maximum emitted light possible, depending on the diagnostic needs and the depth of study wanted.
I also work with Vein Viewer, awarded in 2004 as world best diagnostic device and winner of the Red Hearing Award in 2007. This non-invasive device permits the visualization of the incompetent veins, until 1 cm in depth, and the comparison among images of the same veins before and after the treatment.
Its use in phlebotherapy becomes essential addition to the visualization of the venous blood (in particular, of the red blood cells gathered in the veins that are pathologically subjected to blood stasis and reflux), both in large and small saphenous veins, pathologically suffering from incompetent valves, and in refluxes coming from the perforating veins.
Also in the smallest perforating veins, about 150-200 each limb, you have the possibility to recognize selectively the blood reflux, overcoming limits set by the possibility of a morphologic study of the venous structures, granted by the diagnostic resources everybody knows.
This additional diagnosis deepens the knowledge of the numerous physiopathologies coming from the reflux of the superficial vein circulation of the lower limbs. In that district very often, because of the high pressures of the twitches (more than 300 millimeter Hg of pressure on the perforating veins of the calf), we esteem about 50% of the people suffering from this venous pathology, in such specific district.
A New Concept
Together with the Veinlite, which uses halogen light with changeable intensity on the surface of the skin, projected with fiber optics , the VeinViewer becomes a diagnostic system for superficial vein images, advanced, complete, with interesting perspectives.
Clear results:
“We use the VeinViewer for a million different things from IVs to PICC lines. We are expanding its use into pediatrics because children and babies have very small veins.” Richard A. Baum, MD Chief of Interventional Radiology Brigham and Women’s Hospital
“With VeinViewer, we have been able to avoid expensive and traumatic visits to the OR to obtain venous access. This translates into less risk to the patient and thousands of dollars saved.” Joel A. Saltzman, MD Medical Director, Anesthesia Le Bonheur Children’s Hospital
The VeinViewer fulfills a basic principle, emphasized by the more advanced phlebological American centers: " IF I CAN SEE, I CAN DO IT". Regardless of age, physical condition, color of the skin, the veins of the lower limbs, and not only, can be difficult to locate and access in many patients: locating without hesitations incompetent perforating veins, because of the venous refluxes, can lead us to a " unique mapping" of the venous system of the lower limbs, increasing the perspectives of the therapeutic results.
The Vein Viewer allows to clearly visualize superficial veins and numerous perforating veins with their deep circle in real time, until 1 cm in depth (in reality only the blood reflux can be visualized). VeinViewer has been tested and complies with the standard IEC60601-1-2 for the compatibility and total electromagnetic safety (EMC) and for the safety of emissions for conduction and radiation, with consequent CE and FDA certifications, that have granted its introduction into the Pediatric hospital " Bambin Gesù" in Rome, authorizing its use for the atraumatic neonatal venipuncture.
My job is completely focused on the functional recovery of the veins of the lower limbs: the possibility of the images storage of the pathological veins in B.N. on a USB key, allows to save an BEFORE-AFTER IMAGING during the clinical case treatment, with a patient made aware in order to obtain a patient’s free participation to the diagnosis.
A New Concept: mapping all the incompetent perforating veins otherwise not visualized.
| Ethics and aesthetics are one. Ludwig Wittgenstein |
A theory could be so exact that you have to throw it away. Elias Canetti
|
Basic References:
- Redish W, Petzer RH Localized vascular dilatations of the human skin: capillary microscopy and related studies. Am Heart J 1949;37:106.
- Miyake RK, Duarte FH, Fidelis RJ, Miyake H. New leg veins air coiled treatment using 1064 nm laser combined with sclerotherapy: technique description and one year follow-up. Lasers Med Sci 2003;18:522.
- The Pathology and Surgery of the Veins of the Lower Limb, 2nd ed. By H. Dodd and F.B. Cockett. Edinburgh: Churchill Livingstone, 1976.
- Miyake H , Miyake RK , Tratamento das microvarizes e telangectasia. In: Maffei Fh, Lastria S, Yoshida WB, Rollo HA, editors. Doenc , as vasculares perifericas. Rio de Janeiro: Medsi 2002:p.1563-80.
Venous reflux in the lower limb and blood stasis concept: lack of kinetic speed of the red blood cells at rest in the incompetent superficial veins.
The need of the whole mapping, extended also to the smallest venous reflux, in order to identify the real causes of the pathology, widens the need of a study of methodologies which allows an attentive three-dimensional visualization of the patient’s superficial vein anatomy.
Ethics in the doctor-patient relationship suggests a diagnostic theory intent on an update in regard of that tridimensionality in circulation. It in order to estimate the venous reflux originated in the muscle fascia due to a meiopragia for enlargement of perforating superficial veins.
The lack of Doppler effect at rest in those veins, during the patient’s diagnostic study, ran to the development of 3D methods such as VeinLite 150, Venolux and more research devices employing photons (so the rightly directed simple light), till to the use of near-infrared light that has an excellent reach in order to visualize the smallest blood refluxes of the smallest incompetent perforating veins. The infrared light allows to visualize the refluxed and stagnant venous blood of the enlarged and weary veins, lacking in the necessary kinetics that can be express with the Doppler’s formula: V/C where V= Speed into the vassels of the red blood cells (for example in a not-pathological artery they reach 20mt/s in speed and in the deep veins alternate between 0 and a normal flow rate in speed, due to the respiration) and C= Spreading speed of the ultrasound waves which allow the diagnosis with the eco-doppler.
After a clinostatic and orthostatic exam at rest, we have to consider close to the zero the “flow speed” of the red blood cells which stagnate in the pathological superficial veins. Because of this assumption, the red blood speed is put into action by semeiotic maneuvres which activate the kinetics of the superficial blood refluxes, according to the Doppler’s formula. The following remarks show how much useful could be the integration of the three-dimensional study of the venous refluxes with the Eco Color Doppler examination:
- It is obvious, according to the Spectroscopic Physics, that the ferrous element of the hemoglobin absorbs the high emission light, in the band of the near infrared light. It’s able to disperse a smaller quantity of photonic energy, while the surrounding tissues have a strong index of reflection that makes the computer do a statistical analysis of the accidental and systematic uncertainties as standard deviations from average errors (temperature of the room in which the examination is performed, possible electromagnetic interferences, necessity of a space-time variance in consideration of the “space travel of about 70 cm. in variable air, in the absolute no-vacuum”.
- The obvious introduction is:
The red blood cells, containing Iron, have a systolic speed =20 mt. /sec. in the healthy arteries; (S=60 mt. /sec. in the significant stenoses); in the deep venous circle have variable speeds according to the examined area, but with minimal distinctions absolutely determined by the activity of the respiratory muscles and by the alterations of the endo-pleuric pressures. So that the speed can vary among 0 and the values assigned by the respiratory action, the hydrostatic pressures at a determined h, regarding the right cardiac cavities. - Regarding the (superficial or perforating) veins of the lower limbs, the distinction between clinostatic and orthostatic examination is not relevant, except for a valve insufficiency. However not during a three-dimensional examination of the superficial veins: it can take importance before a phlebectomy, because of a bigger venous reflux, or during an examination of the superficial veins with eco-doppler. It can causes a greater gravitational pressure of the red blood cells, emphasizing the so-called Valsalva maneuver. In this case we recur to the gravity of the hemoglobin Iron for an examination, in small measure, influenced by the muscular movements of the legs, by that of the respiratory muscles and by the capacitance of the pulmonary alveoli (demonstrable with Tc- 99 at the level of the “small circle”):
- Surprise: it is the about S=0 that prevails in such superficial refluxed veins or insufficient veins, (as a stopped heart doesn’t make the blood circulate). The VeinViewer is can confirm it:
- Consider the reflected image as a measurable data with its average and minimal standard deviation: the arteriole of the tissues transport the red blood cells and the hemoglobin Iron more fastly than the veins. The image projected by the VeinViewer (with recording modality and modernization of the reflected spectral status) give back us the ferrous absorption of the near-infrared light, in inverse proportion of the flow speed rate of the Iron.
- Therefore higher is the S, less blood stagnates - less blood stagnates, less Iron there is in order to elaborate the reflected light. At the arterial speed rate of red blood cells (20 mt. /sec.), the refractive index does not allow absorption: it is a clearly visible sign that the reflection-compute-projection cycles have particularly high frequencies. So the linear speed rate of the Iron, and then of the red blood cells that cantain it in the arteries, are in inverse proportion. It’s the contrary for the stasis of the venous flow: it can stagnate, in case of valve insufficiency, almost immovable because of the superficial refluxes. The absorption of the light by the hemoglobin iron has an really high rate, because of the large amount of hemoglobin in the that unit of time, (stagnating and continuously corrected in its cyclical standard deviations from the average).
- The healthy patient (as you can see in the gallery), in the same moment he reaches the couch, allows his perforating veins to empty the superficial veins, with subsequent closure of the valves. The lack of blood tissue in such veins allows a strong index of spectral reflection coming from the tissues, in such hemodynamic condition: so the perfectly continent venous flows are not visible.
- In such superficial venous district, we little take advantage from resolving ability of the venous anatomy, using the eco-doppler methodology: (considering the weight of the probe, the impossibility to perceive spontaneous Doppler effect “unless voluntarily provoke it” in too many superficial veins and perforating veins). Moreover in Phlebology we want to know more about the course of the spontaneous blood reflux, that is about the dysfunctional motion of the liquid or blood tissue, as in the deep venous district of the lower limbs and in the arteries. We not only need to examine the structure of the venous walls or of the really few visible valves with high (and insufficient speed) ultrasound frequencies.
- SO REFLECTION AND ABSORPTION of the infrared (in order to estimate the course of the blood flow): FLOWS which is impossible to perceive without taking advantage of the INDEX of REFLECTION of the LIGHT. The Doppler effect demand to a measurable and quantifiable kinetics according to the minimal speed rate of red blood cells: S/C (datum perfectly quantifiable in the arterial circle and deep venous circle, according to the criteria of the Eco-doppler Physics, applicable to every electromagnetic tipology, unless in the velocimetric spectrum of the light).
References: - John R. Taylor - Introduzione all' analisi degli errori. Lo studio delle incertezze nelle misure fisiche. Zanichelli Editore S.p.A. Seconda edizione italiana Gennaio 2000
- S.L. Meyer, Data Analysis for Scientists and Engineers (John Wiley, 1975);
- P.R. Bevington and K.D. Robinson, Data Reduction and Error Analysis for the Phisical Sciences (McGraw-Hill, 1992)
- Claude Franceschi -prefazione: Giuseppe Zannini, Conservatrice et hemodinamique de l'insuffisanse veineuse en ambulatoire.
- Atlante a Colori di Anatomia: uno Studio Fotografico del Corpo Umano. Johannes W.Rohen, Chihiro Yocochi, Elke Lutjen-Drecoll.
