A Study on Diameter of Perforators and Clinical Severity of Chronic Venous Insufficiency

Abstract

BACKGROUND: Perforator incompetence is an important part of assessment of chronic venous insufficiency (CVI), but the criteria for perforator incompetence and the relationship with clinical severity is not well established. AIM: To study whether measurement of diameter of perforator correlates with clinical severity of venous insufficiency. MATERIALS AND METHODS: One hundred and forty five consecutive patients (168 limbs) with varicose veins were evaluated with Doppler study of lower limb veins. Clinical severity and diameter of perforators were assessed. RESULTS: 23% of patients with clinically mild disease had perforator diameter of 3mm or more, whereas, 62% of moderate and severe disease patients had incompetent perforator. Average diameter of perforator in CVI class 1 & 2 patients was 1.44mm whereas, in class 3 & 4 patients, it was 3.31mm and 3.58mm in class 5 & 6 patients. CONCLUSION: Diameter of perforator compare favourably with clinical severity of chronic venous insufficiency. This study may help to evolve patient management guidelines in perforator incompetence treatment.

Diameter reflux relationship in perforating veins of patients with varicose veins and its correlation with clinical severity of disease

“…15 Study done by Krnic et al reported that number of perforators increases as the CEAP grade increases. 19 In our study we found that the average diameter of incompetent perforators increases as the clinical severity of disease (CEAP) increasesand it was significantly higher in CEAP classes 4 to 6 compared to CEAP classes from 1 to 3.…”

“…15 Study done by Krnic et al reported that diameter of incompetent perforators increases as the CEAP grade increases. 19 But study done by Delis reported that the diameter of incompetent perforators did not change with CEAP class. 18 In our study we found that the best cutoff diameter for predicting perforator vein incompetence was 3.8 mm with sensitivity of >94% and specificity >93%.…”

“…15 Study done by Krnic et al reported that diameter of 3.9 mm or greater was sufficient for predicting the perforator incompetence (the accuracy was 91%). 19 Study done by Yamamoto et al found that a diameter larger than 3.0 mm was 80.4% predictive of reflux. 22 Average diameter for predicting incompetent perforators in various studies in literature is shown in table no.…”