The Role of Ultrasound in the Diagnosis and Treatment of Chronic Venous Insufficiency

Ultrasound Evaluation of Chronic Venous Insufficiency

ABSTRACT

Chronic venous insufficiency is a common condition caused by valvular incompetence and/or obstruction of the lower extremity venous system. Chronic venous insufficiency presents in a wide range of clinical presentations, ranging from mild pain or edema to the development of varicose veins and nonhealing venous ulcers. Doppler ultrasound is the preferred imaging modality in the assessment of this condition and provides both anatomical and functional information in a noninvasive, cost-effective, and radiation-free manner. Knowledge of the anatomy and nomenclature, pathophysiology, equipment requisites, scanning protocols, relevant findings, and reporting nuances is essential to the creation of an accurate and clinically actionable report. Evaluation of the superficial and deep venous system for degree and extent of reflux is necessary to establish the diagnosis and to institute appropriate treatment.

Assessing the Effectiveness of Lower Limb Home Exercises with the Use of a Prototype Exercise Robot for Continuous Passive Movement in People with Tetraparesis in the Long-Term Follow-Up: a Preliminary Report

Introduction: Chronic venous insufficiency is the most commonly occurring vascular disease. One of the major risk factors for its development is long-term sitting or standing in prolonged unchanged position and the nature performed work. Study aim: The aim of this study was to assess the effectiveness of lower limb home exercises limb with the use of the Bella Vena robot following disease onset causing tetraparesis in long-term observation. Materials and methods: A group of 15 patients (43.80 ± 14.97 years) was enrolled in the study. These patients had experienced whiplash injury causing total or partial inertia, with preserved mobility in the ankle joints. The total duration of the observation lasted 8 months (8 visits), during which the following parameters were assessed at the beginning and end of this period: pain intensity – according to the Visual Analogue Scale (VAS), level of saturation on the toe, pulse rate of the lower limb via Doppler ultrasound evaluation of reflux parameters. Result: Statistically significant improvement was achieved after home exercises within the following ranges - quality of pain intensity on VAS (p≤0.01), saturation at the level of the big toe (p≤0.05), Doppler ultrasound: reflux in the right femoral vein (p≤0.05), Doppler ultrasound: reflux in the left femoral vein (p≤0.05) Conclusion: Home exercises with using a prototype of the Bella Vena device showed a moderate effect on improving calf pump in the group of patients with quadriplegia in long-term observation.

Standing and sitting postures at work and symptoms of venous insufficiency - results from questionnaires and a Doppler ultrasound study

Chronic venous insufficiency is the most common vascular disease. One of the major risk factors for its development is long-term sitting or standing in the same position and the nature of the work performed. This study aimed to evaluate the incidence of chronic venous insufficiency in a group of persons employed in workplaces with a predominance of standing or sitting positions, and to determine work-related and non-work risk factors. The research used two tools: questionnaires and medical examinations. The survey comprised 500 people, including 238 men (47.6%) and 262 women (52.4%), aged 25-60 years, 39.75 ± 10.80 years old on average. In addition, a group of 100 randomly selected people was subjected to medical examinations to confirm or exclude chronic venous insufficiency symptoms in the study group. The study showed a statistically significant correlation between postures adopted at work and the symptoms of chronic venous insufficiency of the lower limbs.

Evaluation of the Isokinetic Calf Muscle Strength and the Range of Motion of Joint in C3 Chronic Venous Insufficiency

Purpose

The present study aimed to compare the isokinetic muscle strength and range of motion (ROM) values of the ankle between patients diagnosed with C₃ chronic venous insufficiency (group 1, n=57) and healthy individuals (group 2, n=30).

Materials and Methods

After identifying the venous refilling time (VRT) of all participants, the active ROM of the ankle joint and plantar flexion (PF) and dorsi-flexion (DF) muscle strength in the concentric/concentric mode at angular velocities of 60°/sec and 120°/sec were measured.

Results

No statistically significant differences were found between the demographic data of groups 1 and 2 (P>0.05). In total, 102 lower extremities were included in group 1 and 60 lower extremities in group 2. The VRT of the patients in group 1 was 15.5±5.6 seconds, the PF ROM of the ankle joint was 39.3°±9.5°, and the DF ROM of the ankle joint was 27°±8°; in group 2, the VRT, PF ROM, and DF ROM were 36±8.1 seconds, 41°±6.2°, and 27.2°±7.5°, respectively. Statistically significant differences were found between the two groups in terms of VRT (P<0.05); however, no statistically significant difference was observed in terms of ankle ROM (P>0.05). Statistically significant difference was found in terms of all parameters of isokinetic muscle strength measurements, such as peak torque, peak torque/body weight, total work done, and ratio (DF/PF) in group 1 (P=0.001).

Conclusion

The lower extremity muscle strength of patients with chronic venous insufficiency was low, and this weakness was prominent particularly in the direction of PF.

Frequency and Significance of Perforating Venous Insufficiency in Patients with Chronic Venous Insufficiency of Lower Extremity

OBJECTIVE

The aim of this study was to reveal the frequency and impact of perforating venous insufficiency (PVI) in chronic venous insufficiency (CVI) of lower extremity (LE).

MATERIALS AND METHODS

Between 2012 and 2017, a total of 1154 patients [781 females (67.68%) and 373 males (32.32%), 228 (19.76%) unilateral and 926 (80.24%) bilateral LE] were examined using Doppler ultrasound (US). A total of 2080 venous systems of LEs [31.4% male (n=653) and 68.6% female (n=1427); 1056 left LEs (50.77%) and 1024 right LEs (49.23%)] were examined. All patients had symptoms of venous insufficiency (VI).

RESULTS

PVI was revealed in 27.5% (n=571) of LEs. Varicose veins (VVs) related with perforating vein (PV) were revealed in 44.7% of LEs (n=929). PVI was observed in 50.91% of patients with chronic deep venous thrombosis (DVT), 64.41% with deep venous insufficiency (DVI), 59.81% with great saphenous vein (GSV) insufficiency, 68.49% with small saphenous vein (SSV) insufficiency, 58.65% with accessory GSV insufficiency, and 58.77% with PV associated with VVs. There was a statistically significant relationship between PVI and chronic DVT, DVI, GSV, SSV, and accessory GSV insufficiency (p<0.001). A significant relationship was observed between the increase in PV diameter and the presence of PVI (p<0.001).

CONCLUSION

PVI is quite common in combined VI, and PV evaluation should be a part of LE venous system examination.

Experience of Using Shear Wave Elastography Imaging in Superficial Venous Insufficiency of the Lower Extremity

We investigated the effectiveness of shear wave elastography (SWE) in patients with lower extremity superficial venous insufficiency (VI). A total of 138 symptomatic patients, 51 asymptomatic volunteers, and a total of 359 lower extremities (257 symptomatic, 102 asymptomatic) were examined. All participants underwent Doppler ultrasound (US) evaluation to determine VI and SWE measurements performed by manually drawing vein wall and perivenous tissue with free region of interest at the great saphenous vein (GSV) and small saphenous vein (SSV). The GSV, SSV diameter, VI, and volume flow of reflux were compared with the SWE values. The SWE values of the symptomatic group for GSV and SSV were significantly higher than those of the asymptomatic control group regardless of whether VI was detected by Doppler US (P < 0.001). There was a statistically significant increase in SWE values for the symptomatic group who were diagnosed as having reflux in GSV and SSV (P < 0.001). A significant positive correlation between increased GSV, SSV diameter, and SWE values was seen (P < 0.001). Venous insufficiency can be diagnosed with a 84.7% sensitivity and 84.2% specificity when 2655 m/s was designated as cutoff value, and with a 85.4% sensitivity and 84.2% specificity when 22,350 kPa was designated as the cutoff value in GSV. Venous insufficiency can be diagnosed with a 84.3% sensitivity and 82.4% specificity when 2845 m/s was designated as cutoff value, and with a 85.7% sensitivity and 84.4% specificity when 27,100 kPa was designated as the cutoff value in SSV. Shear wave elastography may be used effectively in addition to conventional Doppler US examination in diagnosing and following VI.

Endovenous laser ablation and foam sclerotherapy for varicose veins: does the presence of perforating vein insufficiency affect the treatment outcome?

BACKGROUND

Superficial venous insufficiency is a common problem associated with varicose veins. Endovenous laser ablation (EVLA) and concomitant ultrasound (US)-guided foam sclerotherapy are recent treatment methods alternative to surgery in the treatment of superficial venous insufficiency.

PURPOSE

To compare the effectiveness of EVLA and concomitant US-guided foam sclerotherapy prospectively in two different subgroups of the disease (isolated truncal vs. truncal with perforating vein insufficiency).

MATERIAL AND METHODS

The study was approved by the institutional review board. Fifty-five patients with symptomatic saphenous vein insufficiency and varicose veins were included in the study. Seventy-three EVLA and concomitant foam sclerotherapy were performed for 60 lower extremities. To determine the severity of the venous disease, Venous Clinical Severity Score (VCSS) and Visual Analogue Scale (VAS) were carried out before and 6 months after the treatment. Patients were followed up clinically and with Doppler ultrasonography for 6 months after the procedures.

RESULTS

At the sixth month of the follow-up; the total occlusion rate for the saphenous veins was 98.64% (72/73), and re-canalization rate was 1.36% (1/73). The total occlusion rate for the perforating veins was 75% (18/24), re-canalization rate was 25% (6/24). There was no notable major complication. VCSS and VAS scores were decreased significantly following the treatment (p < 0.05). The patients who had isolated saphenous vein insufficiency (Group I: 36/60) and those who had saphenous and perforating vein reflux (Group II: 24/60) were compared. VAS scores were more prominently decreased after the treatment in the isolated saphenous vein insufficiency group (p < 0.05). VCSS were also decreased more prominently in Group I when compared to Group II.

CONCLUSION

EVLA and concomitant US-guided foam sclerotherapy are effective, safe, and minimally invasive treatment options, yielding good cosmetic and clinical results in both isolated truncal and truncal with perforating vein insufficiency groups. However, clinical results and satisfaction of the patients were remarkably superior in cases with isolated truncal vein insufficiency compared to truncal and perforating vein insufficiency.