Superficial venous insufficiency: Correlation of anatomic extent of reflux with clinical symptoms and signs

Labropoulos, Nicos; León, Miguel; Nicolaides, Andrew; Giannoukas, Athanasios D.; Volteas, N.; Chan, Pan F.

doi:10.1016/0741-5214(94)90233-x

Cited by 258 publications

(190 citation statements)

References 28 publications

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“…21 In general, the absolute risk of trophic skin changes appears to be greatest with proximal thrombosis, as compared with distal thrombosis, and with deep, or deep and superficial thrombosis, as compared with superficial thrombosis. 20,22,[24][25][26][27][28] These studies have also correlated the severity of skin changes to the number of thrombosed venous segments, and the degree of venous reflux.…”

Section: Epidemiology and Natural Historymentioning

confidence: 99%

“…Among the variety of functional and imaging tests available, duplex ultrasonography is regarded as the method of choice because it is accurate, reproducible, and noninvasive. 28,52 Duplex ultrasonography of the leg consists of real-time, B-mode imaging of the deep and superficial veins combined with directional pulsed Doppler assessment of blood flow. In B-mode imaging, a real-time scanner rapidly and automatically sweeps the ultrasound beam over the area to be imaged and constructs an image from the returned signals and allows for detection of movement in the structures imaged.…”

Section: Diagnostic Testingmentioning

confidence: 99%

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Chronic Venous Insufficiency and Venous Ulceration

Alguire

Mathes

1997

J Gen Intern Med

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OBJECTIVE:To review and summarize the literature on the normal venous circulation of the leg, and the epidemiology, pathophysiology, and treatment of chronic venous insufficiency (CVI).DATA SOURCES: English-language articles identified through a MEDLINE search using the terms venous insufficiency or varicose ulcer and epidemiology, pathophysiology, diagnosis, and clinical trial (pt), and selected cross-references. STUDY SELECTION:Articles on epidemiology, pathophysiology, and treatment of CVI. Randomized, controlled studies were specifically sought for treatment efficacy. DATA EXTRACTION:Data were manually extracted from selected studies and reviews; emphasis was placed on information relevant to the general internist. pproximately 5 million people in the United States exhibit some evidence of chronic venous insufficiency (CVI) and between 400,000 and 500,000 of these individuals have or will develop a venous leg ulcer. 1-3 The signs of CVI include engorgement of the cutaneous veins and dependent edema in mildly affected patients to pigmentation, dermatitis, and ulceration in the more severe cases. Although most patients are asymptomatic, others have leg heaviness and aching or recurrent and recalcitrant leg ulcers punctuated by bouts of cellulitis. These more severe cases are associated with recurrent hospitalization, high health-care costs, and disability. 4,5 Venous insufficiency with trophic skin changes or ulceration is a frustrating problem, which many physicians approach with a sense of ennui. This may be due to the chronic and remitting nature of the problem, the need for lifestyle modification, inconvenient therapies, and contradictory information regarding medical and surgical management. Nevertheless, CVI, including ulceration, is a manageable problem. The purpose of this review is to present the normal anatomy and physiology of the venous circulation and to summarize the epidemiology, pathophysiology, and treatment of CVI. DATA SYNTHESIS: METHODSA MEDLINE search for relevant English-language articles published between 1966 and 1996 was completed using the following MeSH terms: venous insufficiency or varicose ulcer and epidemiology, pathophysiology, diagnosis, and clinical trial (pt). When selecting articles on treatment, randomized, controlled trials were reviewed whenever possible. Emphasis was placed on reviewing articles with clinical relevance for internal medicine physicians. ANATOMY AND NORMAL PHYSIOLOGYVenous blood from the skin and subcutaneous fat is collected in a system of superficial venules and veins that drain toward the deep venous system underneath the fascia via three major pathways: (1) through the long or short saphenous veins, which join the deep system at the saphenofemoral and saphenopopliteal junctions; (2) through the perforating veins originating from the long or short saphenous veins or their branches; or (3) directly into the deep venous system or bypass the deep system entirely and enter the pelvis. 6 Deep veins are categorized as either intramuscular or intermuscular; o...

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Section: Epidemiology and Natural Historymentioning

confidence: 99%

Section: Diagnostic Testingmentioning

confidence: 99%

Chronic Venous Insufficiency and Venous Ulceration

Alguire

Mathes

1997

J Gen Intern Med

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“…Porém, há autores que defendem o uso seletivo do método, utilizando somente em casos em que há varizes no trajeto das safenas e quando há presença de sintomas mais exuberantes, como dor e edema nos membros inferiores, não se indicando o eco-Doppler colorido em pacientes com varizes distantes das veias tronculares (safenas), assintomáticas e sem sinais de insuficiência venosa mais grave (dor, edema ou alterações cutâneas) 27 .…”

Section: Discussionunclassified

Prevalência do refluxo na veia safena parva em varizes primárias não complicadas dos membros inferiores pelo eco-Doppler colorido

Secchi

Miyamotto²,

França³

et al. 2006

J. vasc. bras.

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Objective: To determine the prevalence of small saphenous vein reflux (SSVR) in patients with uncomplicated varicose veins, using color-flow Doppler ultrasonography.Method: Over an 18-month period, a total of 1,953 patients underwent color-flow Doppler ultrasonography for evaluation of venous disease. Out of the total, 1,631 patients with primary uncomplicated varicose veins were selected for this study: 1,383 (84.79%) patients were female and 248 (15.21%) were male. Mean age was 42.9 (± 0.48) years, ranging from 13 to 85 years. Of the 1,631 patients, 1,323 underwent bilateral examination and 308 unilateral examination, for a total of 2,954 lower limbs with primary uncomplicated varicose veins studied. The number of right lower limbs studied was 1,461 and the number of left lower limbs was 1,493. All exams were carried out using the same protocol.Result: Out of the total number of 2,954 limbs, SSVR was detected 372 (12.59%) limbs. Prevalence of SSVR in males was 14.08% and in females was 12.35%. SSVR was detected in the right lower limb in 12.05% and in left lower limb in 13.13% of the cases. SSVR was significantly more common in patients older than 60 years.Conclusion: SSVR is relatively common and its presence should always be investigated in patients with primary lower limb varicose veins. Resultado: Dos 2.954 membros inferiores avaliados, 372 (12,59%) apresentaram refluxo em veia safena parva. A prevalência nos homens foi de 14,08% e, nas mulheres, de 12,35%. O refluxo da safena parva foi maior no membro inferior esquerdo (13.13%) do que no direito (12,05%). A prevalência do refluxo foi significativamente maior nos pacientes acima de 60 anos.Conclusão: O refluxo da veia safena parva é relativamente comum, e sua pesquisa deve ser sempre realizada em pacientes com varizes primárias de membros inferiores.

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“…The refl ux was elicited by Valsalva manoeuvre presented for 5-10 seconds, and was defi ned as a backfl ow lasting ≥ 1 s (ref. 1,6,10,11 ). Haemodynamically signifi cant refl ux had a backfl ow velocity of Vmax ≥ 10 cm/s.…”

Section: Methodsmentioning

confidence: 99%

Width of the Great Saphenous Vein Lumen in the Groin and Occurence of Significant Reflux in the Sapheno-Femoral Junction

Musil

Herman²,

Mazuch³

2008

BIOMED PAP

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Aim:This study was performed to assess the contribution of the width of the anechogenous lumen of the great saphenous vein (GSV) in the groin measured by ultrasound (US) to the diagnostics of haemodynamically signifi cant refl ux (HSR) in the sapheno-femoral junction (SFJ).Methods: We examined 200 lower limbs with primary varicose veins in 182 patients. Duplex scanning was performed with the patients in the supine position. Longitudinaly imaging (B-mode) the inner anechogenous diameter of GSV was measured 4-5 cm distal to SFJ. PW Doppler sampling volume was placed at the same distance. The refl ux was elicited by Valsalve manoeuvre. The HSR was defi ned as a backfl ow lasting ≥ 1 s with a velocity of Vmax ≥ 10 cm/s.Results: The mean width of the GSV with HSR (n=152) was 6.39 mm, median 6.0 mm, SD ± 2.21 mm. The mean width of GSV without HSR (n = 48) was 4.41 mm, median 4.4 mm, SD ± 0.96 mm. The diff erence between the mean widths of GSV was statistically signifi cant (p < 0.01). In GSV < 5 mm (n = 77) HSR (V max ≥ 10 cm/s) was confi rmed in 46 cases (59.7 %), in GSV ≥ 5 mm (n = 123) in 106 cases (86.2 %). The sensitivity of dilatation of GSV ≥ 5 mm for the presence of HSR in SFJ was 69.7 %, specifi city 64.6 %. PPV (positive predictive value) of dilatation of GSV ≥ 5 mm for the presence of HSR in SFJ was 86.2 %, NPV (negative predictive value) was 40.3 %, and the diagnostic accuracy of dilatation of GSV ≥ 5 mm was 68.5 %.Conclusions: Measurement of anechogenous lumen GSV under the groin in B-mode is less sensitive (69.7 %) and less specifi c (64.6 %) in the diagnostics of HSR in SFJ. Only 68.5 % of all measurements of the width of the GSV below the groin in B-mode provided accurate indirect assessment of the functions of valves in SFJ. US scanning of the width of anechogenous lumen of GSV below the groin may serve only for ancillary examination. INTRODUCTIONIn ultrasound examination for venous insuffi ciency of the lower extremities we use duplex scanning to assess the function of venous valves and search for the refl ux. Morphological evaluation of the vein in B-mode (when we focus on the measurement of the anechogenous venous lumen) is only secondary. In case of venous dilatation we consider venous insuffi ciency. Sometimes it is possible to scan venous valves, their motility and reaction to Valsalva manoeuvre or manual compression. However, minor venous valves are diffi cult to scan. The new generation of ultrasonographic devices makes it possible to follow their function and blood-fl ow under both physiological and pathological conditions 12 . In lower extremities with primary varicose veins we can observe insuffi ciency of the sapheno-femoral junction (SFJ) most frequently 7,15 . The cause of trunk varices of the great saphenous vein (GSV) is refl ux in the terminal and preterminal valves in the sapheno-femoral junction 3 . Recent work has already evaluated the relation between the width of GSV and the occurrence of the refl ux in SFJ, and found a statistically

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Superficial venous insufficiency: Correlation of anatomic extent of reflux with clinical symptoms and signs

Cited by 258 publications

References 28 publications

Chronic Venous Insufficiency and Venous Ulceration

Chronic Venous Insufficiency and Venous Ulceration

Prevalência do refluxo na veia safena parva em varizes primárias não complicadas dos membros inferiores pelo eco-Doppler colorido

Width of the Great Saphenous Vein Lumen in the Groin and Occurence of Significant Reflux in the Sapheno-Femoral Junction

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