PHLEBOLITES. CALCAREOUS BODIES IN THE VEINS.
Nature. Location. Mode of formation. Calcareous plates in two inner coats. Phlebotomy. Altered sanguification. Treatment. Extraction.
Calcareous bodies have been repeatedly found in the veins of man and several observations of the same kind have been made in the horse. Spooner found them in the abdominal veins and Simmonds in the jugular. Much difference of opinion has existed as to the mode of formation of these bodies whether by calcareous deposit in a coagulum or by degeneration of a neoplasm in the vascular wall. Andral held the latter opinion, and Tiedemann and Cruveilhier found the bodies connected to the inner coat of the vein by a fine membrane. Morton’s cut of one of Simmonds’ specimens (Calculus Concretions) shows a structure in successive layers having their centre at one end, evidently corresponding to a former connection by pedicle. Cornil and Ranvier says “sometimes there are seen in chronic varices, calcareous incrustations in the form of plates, nodules or spheres with concentric layers ... calcareous infiltration is seen in the form of spheres or phlebolites in the varicose diverticula. An extensive calcareous induration several centimetres in length, is also sometimes observed, the vein being transformed into a calcareous tube with the ramifications also varicose.
The calcareous plates of the vein are developed in the fibrous and internal portion of the middle coat. At the beginning they consist of granules deposited in the fasciculi of the connective tissue or between them; these soon unite and form transparent plates with granular striæ.”
Phlebolites in the jugular suggest a connection with the pouch-like dilatations, and transformations in the vascular walls that have been subjected to phlebotomy. It is probable however that there is usually a morbid condition of sanguification and nutrition which predisposes to their formation. In Simmonds’ case the jugular was impervious below the bodies, there was hepatitis and arthritis of the fetlock joint.
When recognized during life these may be extracted with due antiseptic precautions. If the vein can be dispensed with it may be ligatured above and below, if not an attempt may be made to preserve it, extracting through a clean cut longitudinal incision and securing as perfect coaptation of the edges of the wound as possible.