Postural Diameter Change of the Saphenous Trunk in Chronic Venous Disease

Velden, S.K. van der; Maeseneer, M. De; Pichot, Olivier; Nijsten, Tamar; Bos, R.R. van den

doi:10.1016/j.ejvs.2016.02.019

Cited by 13 publications

(14 citation statements)

References 25 publications

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“…2,11,12 Measurement of the diameter at mid-thigh, usually at about 15 cm from the saphenofemoral junction, in a straight part of the GSV, not at a focal dilatation, appears to be the most reproducible and has therefore also been used for the present study. 12,23,27,28 However, there may be still different ways of measuring the diameter at this standard location. The outer diameter of the vein can be measured (between the outer borders of the adventitia) or the inner diameter (i.e., the diameter of the lumen, between the inner borders of the intima).…”

Section: Discussionmentioning

confidence: 99%

“…Although the UIP consensus document of 2011 12 recommended measuring the external diameter, in view of comparison pre-and post-operatively in an individual patient, it seems to be more applicable to use the inner diameter for screening and pre-operative assessment, which allows for comparison between patient cohorts in different studies. In a recent study about postural diameter change 28 the investigators also measured the inner diameter and the same strategy was used in the present study. Unfortunately, in several studies, diameter measurement has not been performed in a standardised way and often the methodology lacks clarity on details about how venous diameters were measured.…”

Section: Discussionmentioning

confidence: 99%

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Great Saphenous Vein Diameters in Phlebological Practice in France: A Report of the DIAGRAVES Study by the French Society of Phlebology

Hamel-Desnos

Maeseneer

Josnin

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS In routine phlebological practice, only a small minority of patients with venous symptoms and/or clinical signs of chronic venous disorders present with large diameter (>8 mm) incompetent great saphenous veins (GSVs). More than half of the incompetent GSVs are small (<6 mm). This knowledge should influence management strategies in daily practice, with a view to reducing the global cost of treating patients with chronic venous disorders. Objective: The aim was to evaluate the distribution of the diameter of the great saphenous vein (GSV) at midthigh level and to investigate its association with clinical class, symptoms, and proximal extent of reflux. Methods: Vascular physicians, members of the French Society of Phlebology, were invited to participate in a consecutive observational study in patients presenting with symptoms and/or signs of uni-or bilateral chronic venous disorders (CVDs) in previously untreated limbs (clinical class of the CEAP classification C0s e C6). Patients were included between January and March 2015. They completed a specially designed venous symptoms questionnaire. Duplex ultrasound of the included limbs was performed with the patient standing to detect reflux in the GSV and to measure the GSV inner diameter at mid-thigh. Results: Between January and March 2015, 35 physicians examined 1245 patients (2450 limbs after excluding 40 limbs): 77% were female, mean age 52 AE 14; 69% of the patients had venous symptoms in one or both legs. The most frequent symptoms were feeling of heaviness, feeling of swelling and aching. Predominant CEAP clinical classes were C2 (38% of limbs) and C1 (35%). In case of GSV reflux (40% of limbs), the average diameter was 5.6 AE 2 mm and the distribution was 62% < 6 mm, 30% between 6 and 8 mm, and 8% > 8 mm. The study showed a clear association between clinical class and GSV diameter (the higher the clinical class, the larger the diameter; p < .0001), between venous symptoms and diameter (the larger the diameter, the higher the intensity of symptoms, p < .0001 for overall discomfort) and between proximal extent of reflux and diameter (the more proximal the extent of reflux, the larger the diameter, p < .0001). Conclusion: The DIAGRAVES study demonstrated that in France for patients consulting with CVDs, more than half of the incompetent GSVs had a diameter < 6 mm, while large diameters were relatively infrequent. This should be kept in mind when considering management strategies in patients with CVDs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Great Saphenous Vein Diameters in Phlebological Practice in France: A Report of the DIAGRAVES Study by the French Society of Phlebology

Hamel-Desnos

Maeseneer

Josnin

et al. 2019

European Journal of Vascular and Endovascular Surgery

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“…The median PDC has been shown to be significantly lower in C 4e6 limbs than in C 2e3 or C 0e1 at 16%, 21%, and 23%, respectively (p ¼ .016). 13 The explanation may be a decrease in the elastic properties of the venous wall in diseased refluxing veins. Elevated venous pressure in superficial veins while supine may also hamper their responsiveness to collapse.…”

Section: Pdcmentioning

confidence: 99%

Comparison of Four Haemodynamic Tests that Quantify Superficial Venous Insufficiency

Lattimer

Rudolphi

Recke

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Currently, investigations on patients with superficial venous insufficiency are limited invariably to assessing the presence and sites of reflux. This approach is satisfactory for most patients and directs the location of treatment. However, symptoms and signs do not always improve, may not be related to clinical severity, and recurrence is common. For this reason and as in most other chronic diseases, it may be advantageous to have an objective reference standard to quantify the drainage insufficiency and then to measure its response to treatment and follow up. This study investigates four such measurement parameters and their relationships with each other.Objectives: Reflux assessment with ultrasound (U/S) is usually qualitative. Quantitative measurements of superficial venous insufficiency (SVI) include the venous arterial flow index (VAFI), recirculation index (RCI), venous filling index (VFI), and the postural diameter change (PDC) of the saphenous trunk. The aim was to investigate their relationship. Materials and methods: This was an observational study performed on patients with varicose veins and hospital employees. Four haemodynamic parameters were measured in 21 legs from 16 subjects. Legs were divided into no reflux (n ¼ 7) and reflux (n ¼ 14). The VAFI is the U/S ratio of common femoral vein volume flow divided by the common femoral artery volume flow, performed supine. The RCI is the U/S ratio of reflux volume over antegrade volume within the saphenous trunk after calf compression, standing. The VFI is the rate of calf volume increase on dependency measured in mL/s, using air plethysmography. The PDC is the percentage reduction of the saphenous trunk diameter from standing to lying, using U/S. Results: The clinical part of the CEAP classification was:All four tests demonstrated significant differences between the two groups with minimal overlap (Mann Whitney U test): VAFI (p ¼ .028), RCI (p < .0005), VFI (p ¼ .001), and PDC (p ¼ .014). Furthermore, significant correlations were observed with the tests: VAFI vs. RCI (r ¼ .532, p ¼ .015), VFI (r ¼ .489, p ¼ .025) and PDC (r ¼ À.474, p ¼ .030); RCI vs. VFI (r ¼ .446, p ¼ .043) and PDC (r ¼ À.527, p ¼ .014). Conclusions: Superficial venous drainage insufficiency should not be confined to an U/S assessment of the presence of reflux, which is qualitative. Quantitative data may be provided using the VAFI, RCI, VFI, and PDC. Understanding why there are significant correlations among these parameters and the preferred objective reference test requires further work.

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“…In limbs with saphenous vein reflux, the changes were smaller in patients with chronic venous disease (CVD) with a CEAP (clinical, etiologic, anatomic, pathophysiologic) category of C4 to C6 than in patients with C0 to C1 or C2 to C3. 16 Blood vessel walls are viscoelastic, combining features of elastic solids and viscous fluids. 17 Elasticity, illustrated by the slope of the volumeepressure function, is the ability of the vessel wall to resist a distending force and return to its original shape and size when this force recedes.…”

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confidence: 99%

Noninvasive measurement of venous wall deformation induced by changes in transmural pressure shows altered viscoelasticity in patients with chronic venous disease

Mestre

Triboulet

Dematteï

et al. 2021

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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Objective: The noninvasive measurement of venous wall deformation induced by changes in transmural pressure could allow for the assessment of viscoelasticity and differentiating normal from diseased veins. Methods:In 57 patients with limbs in the C1s (telangiectasia or reticular veins and symptoms), C3 (edema), or C5 (healed venous ulcer) CEAP (clinical, etiologic, anatomic, pathophysiologic) category of chronic venous disease and 54 matched healthy controls, we measured the changes in the cross-sectional area of the small saphenous vein and a deep calf vein in the supine and standing positions and under compression with an ultrasound probe using ultrasonography.Results: The small saphenous vein, but not the deep calf vein, cross-sectional area was smaller in the limbs of the controls than in the limbs with C3 or C5 disease but was not different from that in C1s limbs. When changing from the supine to the standing position, a greater force was required to collapse the leg veins. Their cross-sectional area increased in most subjects but decreased in 31.5% of them as for the small saphenous veins and 40.5% for the deep calf vein. The small saphenous vein area vs compression force function followed a hysteresis loop, demonstrating viscoelastic features. Its area, which represents the viscosity component, was greater (P < .001) in the pooled C3 and C5 limbs (median, 2.40 N$mm 2 ; lower quartile [Q1] to upper quartile [Q3], 1.

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Postural Diameter Change of the Saphenous Trunk in Chronic Venous Disease

Abstract: Low PDC of the ST correlates with older age and increased BMI. Whether PDC might become a useful additional DUS tool to classify the severity of chronic venous disease and thereby influence the management strategy should be further investigated.

Cited by 13 publications

References 25 publications

Great Saphenous Vein Diameters in Phlebological Practice in France: A Report of the DIAGRAVES Study by the French Society of Phlebology

Great Saphenous Vein Diameters in Phlebological Practice in France: A Report of the DIAGRAVES Study by the French Society of Phlebology

Comparison of Four Haemodynamic Tests that Quantify Superficial Venous Insufficiency

Noninvasive measurement of venous wall deformation induced by changes in transmural pressure shows altered viscoelasticity in patients with chronic venous disease

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