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Guven H. Plethysmography: A game changer for chronic venous insufficiency diagnosis, treatment, and follow-up. Vascular 2024:17085381241240870. [PMID: 38509041 DOI: 10.1177/17085381241240870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Chronic Venous Insufficiency (CVI) presents a various clinical symptoms and treatment options. Although it is generally known which treatment option is more appropriate in which situations in CVI, it is even more difficult to find the right option in some uncertain situations. In this study, we aimed to evaluate the potential contribution of Digital Photoplethysmography (D-PPG) in the diagnosis of CVI and especially in the selection of treatment options. PATIENTS AND METHOD This retrospective study was conducted at Bursa Heart and Arrhythmia Hospital, involving 721 consecutive patients diagnosed with CVI and with Endovenous Laser Ablation (EVLA) indication. The patients were divided into 2 groups according to the extent of the failure in Doppler USG. In Group 1, the insufficiency ended above the knee, and in Group 2, the insufficiency progressed to below the knee. Patients were evaluated based on anamnesis, physical examination, Doppler USG, and D-PPG. Clinical classification, Venous Clinic Severity Score (VCSS), Quality of Life (QoL) assessment, venous pump capacity (VPC), and venous refill time (VRT) were measured. RESULTS The study included 263 male and 458 female patients with a mean age of 52.37 ± 12.26 years. Significant differences were observed between Group 1 (above knee reflux) and Group 2 (below knee reflux) patients in terms of VCSS, QoL, VPC, and VRT values. The mean values of VCSS, patient complaints, VPC, and VRT were higher in Group 2 patients. Similar findings were observed within the CEAP 2 subgroup. CONCLUSION D-PPG shows potential as a valuable tool in the diagnosis and treatment of CVI. By providing information about venous hemodynamics and volume changes, it can assist in optimizing treatment decisions, including saphenous vein preservation. Combining D-PPG with Doppler USG may improve the comprehensive assessment of CVI and change the treatment option, especially for CEAP 2 patients. More research is needed to confirm these findings and explore wider applications of plethysmographic methods in the management of CVI.
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Affiliation(s)
- Hakan Guven
- Department of Cardiovascular Surgery, Heart an Arrythmia Hospital, Bursa, Türkiye
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2
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Effect of Obesity and Bariatric Surgery on Saphenous Veins. Obes Surg 2023; 33:821-825. [PMID: 36701009 DOI: 10.1007/s11695-023-06469-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/07/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE Obesity is a risk factor for chronic venous disease (CVD) of the lower limbs (LL), affecting venous anatomy and physiology. Weight loss after bariatric surgery (BS) can reduce intra-abdominal pressure, improve mobility, and ultimately improve venous hemodynamics and CVD-related symptoms. There are no studies in the literature that adequately assess the effect of the obesity and BS on the LL veins, especially the saphenous veins (SV). The aim of this study was to evaluate the effects of obesity and BS on the saphenous veins. METHODS This is a longitudinal prospective study carried out from 2019 to 2021 with 19 patients, totaling 38 LL, underwent clinical evaluation (CEAP Classification) and by Doppler ultrasonography, to analyze their SV diameter and reflux measurements, in the preoperative period and again 6 months to 2 years after BS being performed. RESULTS There was no statistical difference between the groups regarding the characteristics of reflux in the SV among the evaluated LL. There was no significant increase in the diameter of the great SV in the majority of its segments. The groups were similar in terms of the small SV diameters. Moreover, a significant reduction in the clinical class of CEAP was observed after BS. CONCLUSION Obesity and bariatric surgery had no influence on diameter or reflux in saphenous veins, but a reduction in the CEAP Clinical Classification was observed in the postoperative period.
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Association between duplex ultrasonography findings and severity of chronic venous disease in Thai patients. Asian J Surg 2022:S1015-9584(22)01437-3. [DOI: 10.1016/j.asjsur.2022.09.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/21/2022] [Accepted: 09/26/2022] [Indexed: 11/20/2022] Open
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Nelzén POE, Skoog J, Zachrisson H. Relationship between clinical severity and hemodynamic impact of great saphenous vein incompetence using strain gauge plethysmography and duplex ultrasound. Phlebology 2022; 37:579-587. [DOI: 10.1177/02683555221101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To evaluate the relation of quantitative Duplex ultrasound (DUS) and strain gauge plethysmography (SGP) parameters with clinical severity and quality of life in patients with superficial venous incompetence. Methods DUS volume flow and distal SGP refilling times (T50 and T90) were evaluated in 152 patients (164 Limbs) with superficial incompetence. Clinical severity and quality of life were evaluated with C of the CEAP classification, venous clinical severity score (VCSS), Aberdeen varicose vein questionnaire (AVVQ), and EuroQol 5D-3L. Results Higher DUS volume flow was associated with higher C in CEAP scores. Volume flow was also related to T50 and T90. Shorter T50 and T90 were associated with higher C in CEAP and VCSS. T50 was also associated with EQ-5DVAS. Reflux extension to the foot wase associated with shorter T50 and T90 and higher DUS volume flow. Conclusions DUS volume flow and SGP refilling times are related with clinical severity and provide quantitative information regarding venous function in patients with superficial incompetence.
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Affiliation(s)
- P Oskar E Nelzén
- Department of Thoracic and Vascular Surgery and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johan Skoog
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Helene Zachrisson
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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5
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Hong KP. Correlation of Clinical Class with Duplex Ultrasound Findings in Lower Limb Chronic Venous Disease. J Chest Surg 2022; 55:233-238. [PMID: 35478179 PMCID: PMC9178300 DOI: 10.5090/jcs.22.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/20/2022] [Accepted: 04/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background This study investigated the distribution of valve incompetence in patients with chronic venous disease (CVD) and its correlation with the clinical category of the clinical, etiological, anatomical, and pathophysiological (CEAP) classification. Methods In total, 1,386 limbs with clinically suspected CVD were categorized according to the CEAP classification and consecutively underwent duplex ultrasonography between April 2017 and December 2020. Results There were 362 limbs in male patients and 1,024 limbs in female patients. The limbs were classified as C0s–C1 (608 limbs, 43.8%), C2 (727 limbs, 52.5%), or C3–C6 (51 limbs, 3.7%). The prevalence of saphenous vein incompetence in CEAP C0s–C1 limbs was 43.6%. The saphenofemoral junction (SFJ) was competent in 37% of CEAP C2–C6 limbs. The CEAP C3–C6 category was not correlated with reflux patterns of the saphenous vein system (Cramer’s V=0.07), incompetent SFJ (Cramer’s V=0.07), deep vein reflux (Cramer’s V=0.03), or the distribution of incompetent segments in the great saphenous vein (GSV) (Cramer’s V=0.11). Conclusion Duplex ultrasonography is necessary to formulate a proper treatment plan for limbs categorized as CEAP C0s–C1. The SFJ was competent in more than one-third of CEAP C2–C6 limbs with GSV reflux; as such, flush ligation of the GSV may be unnecessary in these patients. The CEAP C3–C6 category showed no correlations with reflux patterns of the saphenous vein system, SFJ reflux, deep vein reflux, or the distribution of incompetent segments in the GSV.
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Affiliation(s)
- Ki Pyo Hong
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Blood Flow Analysis of the Great Saphenous Vein in the Su-Pine Position in Clinical Manifestations of Varicose Veins of Different Severities: Application of Phase-Contrast Magnetic Resonance Imaging Data. Diagnostics (Basel) 2022; 12:diagnostics12010118. [PMID: 35054283 PMCID: PMC8774923 DOI: 10.3390/diagnostics12010118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 11/17/2022] Open
Abstract
The progression of clinical manifestations of lower-limb varicose veins remains unclear. This study investigated changes in lower-limb venous blood flow using phase-contrast magnetic resonance angiography. Data were collected on veins from 141 legs. We compared legs with and without varicose veins and related symptoms and examined varying levels of varicose vein symptom severity. Legs without varicose veins exhibited a lower absolute stroke volume (ASV, p < 0.01) and mean flux (MF, p = 0.03) for the great saphenous vein (GSV) compared with legs with symptomatic varicose veins. Legs with asymptomatic varicose veins exhibited lower MF for the GSV (p = 0.02) compared with legs with symptomatic varicose veins. Among legs with varicose veins, asymptomatic legs exhibited lower ASV (p = 0.03) and MF (p = 0.046) for the GSV compared with legs that exhibited skin changes or ulcers; however, no significant differences were observed between legs presenting with discomfort or edema and legs with skin changes or ulcers, and between legs presenting with discomfort or edema and asymptomatic legs. In conclusion, in the supine position, increased blood flow rate and blood flow volume in the GSV were associated with symptomatic varicose veins and increased symptom severity.
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Chronic venous disease: clinical and Doppler assessments in its prognostic. ANGIOLOGIA 2022. [DOI: 10.20960/angiologia.00409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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8
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Mühlberger D, Zumholz AK, Brenner E, Mumme A, Stücker M, Falkenstein T, Hummel T. Cellular senescence at the saphenofemoral junction in patients with healthy, primary varicose and recurrent varicose veins - A pilot study. Vascular 2021; 30:559-567. [PMID: 33938326 DOI: 10.1177/17085381211012882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Cellular senescence could play a role in the development of venous disease. Superficial venous reflux at the saphenofemoral junction is a common finding in patients with primary varicose veins. Furthermore, reflux in this essential area is associated with higher clinical stages of the disease and recurrent varicose veins. Therefore, this pilot study aimed to investigate cellular senescence in the immediate area of the saphenofemoral junction in patients with healthy veins, primary varicose veins and additionally in patients with recurrent varicose veins due to a left venous stump. METHODS We analyzed vein specimens of the great saphenous vein immediately at the saphenofemoral junction. Healthy veins were collected from patients who underwent arterial bypass reconstructions. Samples with superficial venous reflux derived from patients who received high ligation and stripping or redo-surgery at the groin, respectively. Sections were stained for p53, p21, and p16 as markers for cellular senescence and Ki67 as a proliferation marker. RESULTS A total of 30 samples were examined (10 healthy, 10 primary varicose, and 10 recurrent varicose veins). We detected 2.10% p53+ nuclei in the healthy vein group, 3.12% in the primary varicose vein group and 1.53% in the recurrent varicose vein group, respectively. These differences were statistically significant (p = 0.021). In the healthy vein group, we found 0.43% p16+ nuclei. In the primary varicose vein group, we found 0.34% p16+ nuclei, and in the recurrent varicose vein group, we found 0.74% p16+ nuclei. At the p < 0.05 level, the three groups tended to be significant without reaching statistical significance (p = 0.085). There was no difference in respect of p21 and Ki67. CONCLUSION We found significantly higher expression rates of p53 in primary varicose veins at the saphenofemoral junction than in healthy veins. p16 expression tended to be increased in the recurrent varicose vein group. These preliminary findings indicate that cellular senescence may have an impact in the development of varicose veins or recurrence. Further studies addressing this issue are necessary.
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Affiliation(s)
- Dominic Mühlberger
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Clinic of the Ruhr University Bochum, Bochum, Germany.,Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Anne-Katrin Zumholz
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Clinic of the Ruhr University Bochum, Bochum, Germany
| | - Erich Brenner
- Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Achim Mumme
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Clinic of the Ruhr University Bochum, Bochum, Germany.,Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Markus Stücker
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany.,Department of Dermatology, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Clinic of the Ruhr University Bochum, Bochum, Germany
| | - Thomas Falkenstein
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Clinic of the Ruhr University Bochum, Bochum, Germany.,Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Thomas Hummel
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Clinic of the Ruhr University Bochum, Bochum, Germany.,Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
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9
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Hummel T, Aryafar A, Mayböck N, Mumme A, Stücker M, Mühlberger D. "Quality of Life after Varicose Vein Surgery in Patients with High-ligation and Stripping, External Valvuloplasty and Sapheno-femoral Redo Surgery". Ann Vasc Surg 2021; 74:331-338. [PMID: 33548404 DOI: 10.1016/j.avsg.2020.12.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/17/2020] [Accepted: 12/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-ligation and stripping (HL/S) and external valvuloplasty (eVP) with the implantation of an external device to restore the valve's function, are surgical methods to eliminate reflux at the saphenofemoral junction. Furthermore, redo-surgery (RedoS) can be performed in terms of same side groin recurrences. It is unclear, if there is a difference in quality of life (QoL) between these 3 surgical treatment options. Therefore, it was the aim of our study to elucidate QoL in patients before and after surgical treatment at the saphenofemoral junction by comparing HL/S, eVP, and RedoS. METHODS A total of 303 participants (156 HL/S, 81eVP, 64 RedoS) were recruited during the daily clinical routine. QoL was measured at admission and 6 weeks after the surgical procedure by means of SF-12 (12 item short form health survey) and Aberdeen Varicose Vein Questionnaire. RESULTS The mean value of Aberdeen Varicose Vein Questionnaire was 14.5 (SD 2.1) preoperatively and 4.9 (SD 3.3) postoperatively in the HL/S group, 16.4 (SD 1.4) preoperatively and 6.8 (SD 2.5) postoperatively in the eVP group and 15.5 (2.2) preoperatively and 5.8 (SD 4.2) postoperatively in the RedoS group, which was statistically significant (P< 0.05) in all groups. Postoperatively, the mean values were statistically significant within the groups. Concerning physical aspects of the SF-12 we found a significant improvement in the RedoS group, while mental aspects were significantly better in the HL/S and eVP group postoperatively. Nevertheless, the clinical relevance of these SF-12 differences is questionable under consideration of the minimal important difference. CONCLUSIONS Varicose vein surgery leads to a significant improvement of QoL in all groups. The implantation of an external patch could have a negative influence in QoL.
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Affiliation(s)
- Thomas Hummel
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Germany; Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Germany
| | - Annahita Aryafar
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Germany
| | - Nora Mayböck
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Germany; Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Germany
| | - Achim Mumme
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Germany; Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Germany
| | - Markus Stücker
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Germany; Department of Dermatology, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Germany
| | - Dominic Mühlberger
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Germany; Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Germany.
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Yılmaz S, Çakır Peköz B, Dincer N, Deniz S, Oğuzkurt L. Classification of reflux patterns in patients with great saphenous vein insufficiency and correlation with clinical severity. ACTA ACUST UNITED AC 2021; 27:219-224. [PMID: 33517254 DOI: 10.5152/dir.2021.19580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE This study aims to establish a clinically applicable classification of reflux patterns in patients with great saphenous vein insufficiency and to evaluate the relationship between this classification, the demographics, and severity of clinical findings. METHODS This is a retrospective study from prospectively collected data of 503 patients who had the complaint of varicose vein. All patients had complete physical examination and their medical history was recorded. Lower limbs of all patients were examined with Doppler ultrasonography. A total of 787 limbs with great saphenous vein insufficiency were included in the analysis. The reflux patterns of great saphenous vein insufficiency were classified into 4 types as: type 1, great saphenous vein reflux without involvement of malleolar region and saphenofemoral junction (SFJ); type 2, reflux involving malleolar region with competent SFJ; type 3, reflux involving SFJ with competent malleolar region; and type 4, reflux involving both the SFJ and the malleolar region. We evaluated the association between the classification of great saphenous vein insufficiency and age, sex, body mass index (BMI), disease duration, clinical, etiological, anatomical and pathophysiological elements (CEAP) classification and venous clinical severity score (VCSS). RESULTS The mean age of the patients was 45.3±11.7 years, with a male-to-female ratio of 2:3. The most common reflux pattern in patients with great saphenous vein insufficiency was type 3 (48.9%), while 14.8% of patients had type 1, 10.4% had type 2, and 25.7% had type 4. Patients with type I reflux pattern were younger in age (p = 0.002), had lower BMI (p = 0.002), fewer number of children (p = 0.008), as well as milder clinical severity score (p = 0.002) compared to other reflux types. Duration of disease symptoms was not significantly correlated with the reflux patterns, but VCSS increased with the involvement of malleolar region as in type 2 compared to type 1 (2.82±1.67 vs. 2.74±2.31), and further increased with the involvement of SFJ as in type 3 (4.13±2.92 vs. 2.82±1.67). Patients with diffuse reflux pattern (type 4) had the most severe clinical presentation (4.59±2.9). CONCLUSION We developed a clinically applicable classification of reflux patterns in patients with great saphenous vein insufficiency based on the involvement of malleolar region and/or SFJ. We showed an association between weight, BMI, VCSS, CEAP classification and the extent of insufficiency.
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Affiliation(s)
- Sezen Yılmaz
- School of Medicine,Koç University, Istanbul, Turkey
| | - Burçak Çakır Peköz
- University of Health Sciences, Adana Health Practices and Research Center, Adana, Turkey
| | - Neris Dincer
- School of Medicine,Koç University, Istanbul, Turkey
| | - Sinan Deniz
- Department of Diagnostic and Interventional Radiology, Koç University Hospital, Istanbul, Turkey
| | - Levent Oğuzkurt
- Department of Diagnostic and Interventional Radiology, Koç University Hospital, Istanbul, Turkey
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Jain P, Savlania A, Behera A, Gorsi U. Distribution patterns of pathological venous reflux and risk factors in patients with skin changes due to primary venous disease in North India. Phlebology 2020; 36:209-216. [PMID: 32931383 DOI: 10.1177/0268355520957193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the distribution patterns of pathological venous reflux and risk factors in patients with skin changes due to primary venous disease. METHODS Two hundred limbs belonging to C4, C5 & C6 classes were examined with duplex ultrasound to determine the sites of reflux. We also analyzed the correlation of risk factors with patterns and severity of disease. RESULTS Among 200 limbs, superficial system reflux was found in 163 limbs (81.5%), deep system reflux in 10 limbs (5%) and perforator system reflux in 180 limbs (90%). The most common pattern of abnormality was combined superficial and perforator system reflux. Of all the risk factors, prolonged standing, obesity and in the female history of pregnancy preceding varicose occurrence had the highest prevalence. CONCLUSIONS In patients with primary chronic venous disease, lifestyle modification is required to avoid risk associated with obesity and prolonged standing. The higher prevalence of pathological perforator reflux in association with advanced venous disease necessitates careful treatment of this least reported pathology to achieve better treatment results.
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Affiliation(s)
- Prashant Jain
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Savlania
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunanshu Behera
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Comparison of hand-held acoustic Doppler with point-of-care portable color Doppler ultrasound in the assessment of venous reflux disease. J Vasc Surg Venous Lymphat Disord 2020; 8:831-839.e2. [PMID: 32184080 DOI: 10.1016/j.jvsv.2019.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/23/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Diagnostic-quality portable color Doppler ultrasound (PCD) offers convenient point-of-care venous reflux disease (VRD) diagnosis. Philips Lumify (Philips N.V., Best, The Netherlands), a high-fidelity broadband linear array transducer (4-12 MHz frequency), connects through a web-enabled smartphone or tablet to cloud software and offers B-mode and color Doppler imaging without pulsed wave Doppler capability. The aims of the study were to compare hand-held acoustic Doppler (HHD) vs PCD diagnostic performance using conventional duplex ultrasound (DUP) as the "gold standard" for VRD assessment, to assess effects of body mass index (BMI) and disease severity on diagnostic performance of HHD and PCD, and to determine whether PCD offers any diagnostic improvement over HHD in VRD assessment. METHODS There were 241 patients (65 male, 176 female; mean age, 55.5 ± 15.5 years; mean BMI, 32.2 ± 7.9 kg/m2). DUP (447 legs), PCD (262 legs), and HHD (217 legs) studied the great saphenous vein at above-knee (AK) and below-knee (BK) levels. A phlebologist performed HHD, whereas PCD and DUP were performed sequentially (PCD first) by an experienced technologist and interpreted independently. PCD was done blinded to DUP results. DUP findings were analyzed blinded to HHD and PCD results. Venous reflux was dichotomously assessed as <2 seconds and >2 seconds. RESULTS HHD improves from moderate to good sensitivity from AK level (68%) to BK level (94%) but suffers poor specificity that declines significantly from AK level (50%) to BK level (12%; P < .05). HHD positive predictive value exceeds its negative predictive value (NPV) and remains unchanged from AK level (71%) to BK level (72%). HHD NPV remains consistently poor at AK (48%) and BK (42%) levels. PCD has similar sensitivity from AK level (69%) to BK level (74%), better AK level (79%) vs BK level (58%) specificity (P < .05), similar positive predictive value for AK (76%) and BK levels (78%), and better NPV for AK level (72%) vs BK level (53%; P < .05). BMI range (<30 kg/m2 vs ≥ 30 kg/m2) did not influence diagnostic performance of HHD and PCD significantly. HHD and PCD specificity was higher for Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class <4 compared with CEAP class ≥4 (P < .05). CONCLUSIONS The relative diagnostic performance of HHD and PCD is highly dependent on insonation level. PCD advantages compared with HHD are marginally greater specificity at AK and BK levels and better NPV at AK level. Compared with HHD, PCD's disadvantage is lower sensitivity at BK level. Both HHD and PCD have higher specificity at AK level than at BK level. Overall, PCD offers only moderate sensitivity and specificity, making it inadequate for exclusion of significant venous reflux. Neither obesity nor CEAP class significantly influenced the general diagnostic performance of PCD or HHD.
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Alwahbi A, Alamri A, Alotaibi W. Risk Factors of Saphenous Vein Insufficiency in Female Patients in Riyadh, Saudi Arabia. Cureus 2020; 12:e6643. [PMID: 31966948 PMCID: PMC6961556 DOI: 10.7759/cureus.6643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Venous reflux most frequently occurs in the great saphenous vein (GSV), which is the most commonly diseased vein and is associated with venous insufficiency and varicose veins. OBJECTIVE We aimed, in this study, to determine risk factors for saphenous vein insufficiency in female patients in Riyadh, Saudi Arabia. METHODS This was a retrospective cohort study. Data were collected from the medical records of adult female patients who developed saphenous vein insufficiency at King Abdulaziz Medical City, between 2015 and 2017. RESULTS A total of 97 subjects participated in the study, 53 patients had saphenous vein reflux while 44 patients did not have reflux. Leg swelling was the only symptom that showed a significant difference between the two groups (p<0.001); patients with reflux had significantly higher rates of endovenous laser therapy (p=0.021). While the same patient group showed significantly lower rates of sclerotherapy compared to patients without reflux (p=0.006). The proportion of hypertension patients without reflux (22.7%) was significantly larger than that of hypertension patients with reflux (1.9%) (p= 0.001). CONCLUSION More research is encouraged to provide better understanding and management of saphenous vein insufficiency in the Saudi population, especially in females who are at high risk.
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Affiliation(s)
- Abdullah Alwahbi
- Vascular Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Amal Alamri
- Vascular Surgery, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Wafa Alotaibi
- Vascular Surgery, King Saud Bin Abdulaziz University for Health Sciences (ksau-Hs), Riyadh, Saudi Arabia, Riyadh, SAU
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Panpikoon T, Wedsart B, Treesit T, Chansanti O, Bua-ngam C. Duplex ultrasound findings and clinical classification of lower extremity chronic venous insufficiency in a Thai population. J Vasc Surg Venous Lymphat Disord 2019; 7:349-355. [DOI: 10.1016/j.jvsv.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/29/2018] [Indexed: 10/27/2022]
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Engelhorn CA, Coral FE, Soares ICM, Corrêa GFDA, Ogeda JP, Hara LY, Murasse LS. Padrões de refluxo nas veias safenas em homens com insuficiência venosa crônica. J Vasc Bras 2017; 15:268-274. [PMID: 29930603 PMCID: PMC5829724 DOI: 10.1590/1677-5449.005016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Contexto A insuficiência venosa crônica (IVCr) é frequente e predomina nas mulheres, mas ainda há poucas informações sobre o refluxo nas veias safenas na população masculina. Objetivos Identificar os diferentes padrões de refluxo nas veias safenas magnas (VSMs) e parvas (VSPs) em homens, correlacionando esses dados com a apresentação clínica conforme a classificação Clínica, Etiológica, Anatômica e Fisiopatológica (CEAP). Métodos Foram avaliados 369 membros inferiores de 207 homens pela ultrassonografia vascular (UV) com diagnóstico clínico de IVCr primária. As variáveis analisadas foram a classificação CEAP, o padrão de refluxo nas VSMs e VSPs e a correlação entre os dois. Resultados Nos 369 membros avaliados, 72,9% das VSMs apresentaram refluxo com predominância do padrão segmentar (33,8%). Nas VSPs, 16% dos membros inferiores analisados apresentaram refluxo, sendo o mais frequente o padrão distal (33,9%). Dos membros classificados como C4, C5 e C6, 100% apresentaram refluxo na VSM com predominância do refluxo proximal (25,64%), e 38,46% apresentaram refluxo na VSP com equivalência entre os padrões distal e proximal (33,3%). Refluxo na junção safeno-femoral (JSF) foi detectado em 7,1% dos membros nas classes C0 e C1, 35,6% nas classes C2 e C3, e 64,1% nas classes C4 a C6. Conclusões O padrão de refluxo segmentar é predominante na VSM, e o padrão de refluxo distal é predominante na VSP. A ocorrência de refluxo na JSF é maior em pacientes com IVCr mais avançada.
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Zollmann P, Zollmann C, Zollmann P, Veltman J, Kerzig D, Doerler M, Stücker M. Determining the origin of superficial venous reflux in the groin with duplex ultrasound and implications for varicose vein surgery. J Vasc Surg Venous Lymphat Disord 2017; 5:82-86. [DOI: 10.1016/j.jvsv.2016.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Screening for lower extremity venous disease. Clin Imaging 2016; 40:325-9. [DOI: 10.1016/j.clinimag.2015.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 12/21/2015] [Indexed: 11/23/2022]
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Birgitte Maessen-Visch M, Smeets L, van Vleuten C. Duplex investigations in children: Are clinical signs in children with venous disorders relevant? Phlebology 2014; 30:719-23. [PMID: 25326215 DOI: 10.1177/0268355514556143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Ultra sound colored duplex sonography is the preferred method in diagnosing chronic venous disease. Data in children on incidence, indications, and results are lacking. METHODS From the total of 9180 duplex investigations performed in our hospital from 2009 to 2012, data on indication and results of the investigation as well as patient characteristics were evaluated retrospectively for the proportion of pediatric patients. RESULTS Duplex investigations were performed 49 times in 38 children (6-18 years), with an average of 1.3 times (1-6 times) per child. Forty percent showed abnormalities: 17 times deep venous thrombosis was suspected; deep venous thrombosis was objectified in 18%. In the 21 investigations performed for varicosis-related complaints, varicose veins or venous malformations were objectified in 57%. Edema was never a symptom of chronic venous disease. CONCLUSIONS Duplex investigation is not often performed in children. In children with established deep venous thrombosis, a family history with deep venous thrombosis is common. In general, edema was not seen in children with varicose veins and, therefore, does not seem a reliable clinical sign at young age.
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Affiliation(s)
| | - L Smeets
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - C van Vleuten
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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