Classification of reflux patterns in patients with great saphenous vein insufficiency and correlation with clinical severity

Abstract

T he appearance of varicose veins in the lower extremities is a prevalent condition associated with a wide range of lower limb symptoms such as pain, heaviness, night cramps, itchiness, swelling, and numbness (1-3). It is commonly caused by chronic venous insufficiency in superficial venous system, and great saphenous vein (GSV) comprises most of the superficial venous insufficiencies (82.7%), followed by small saphenous vein insufficiencies (10.9%) (4). Superficial venous insufficiency shows segmental involvement as demonstrated by previous studies (5). However, a standardized anatomical classification of superficial venous insufficiencies based on Doppler ultrasonography mapping is not readily available.Venous insufficiency mapping is important to decide the treatment planning for an individual patient. The main aim of the current treatment in venous insufficiency is to alleviate the complaints of the patients and to prevent future complications and recurrences. Treat- PURPOSEThis 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. METHODSThis 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). RESULTSThe 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...

Great Saphenous Vein Insufficiency Evaluating the Impact of Reflux Pattern on Clinical Severity and Treatment Modality

“…Conventionally, the reflux is called venous flow in the opposite direction, longer than 0.5 seconds after provocation (squeezing and releasing with or without the Valsalva) maneuvers [16]. As previously described in the recent literature [10] to Doppler US findings, we classified GSV reflux patterns into four types, as illustrated in Figure 1. Type 1, primary GSV reflux with or without the involvement of some superficial branches; type 2, reflux involving the malleolar area with competent SFJ (saphenofemoral junction); type 3, reflux involving SFJ with the competent malleolar area; type 4, reflux involving both malleolar region and SFJ.…”

“…A practical and widely accepted clinical classification of venous insufficiency has not yet been established. As mentioned in some other studies [10], it is clear that there is a need for a widely accepted, clearly understandable, effective, and practical anatomical classification of reflux patterns.…”

“…Cyanoacrylate glue embolization (CGE) has been one of the non-thermal techniques. Unless any region with insufficiency is treated, symptoms may persist and cause recurrent varicose veins in the long term [6][7][8][9][10]. Therefore, it is necessary to determine the pathological segment with venous insufficiency and choose the most convenient treatment option accordingly.…”

“…This study aimed to assess the validity and effects on the clinical severity of a recently defined and easily applicable reflux classification system [10] in patients with GSV insufficiency. Furthermore, we investigated the effect of reflux patterns on the preference of the treatment modality.…”

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

“…However, the mechanism underlying venous disease progression from mild to severe remains unclear [ 6 ]. In addition, the severity of venous reflux does not correlate entirely with the severity of clinical manifestations, which can be influenced by many other factors, including age, sex, deep vein reflux, and the involved venous segment [ 7 , 8 , 9 ].…”