The Analysis of Selected Morphological and Hemodynamic Parameters of the Venous System and Their Presumable Impact on the Risk of Recurrence after Varicose Vein Treatment

Abstract

Introduction: The current treatment of venous disease is focused on reflux elimination in main venous trunks, especially in the saphenous vein. However, a high recurrence rate, independent of the method of treatment, suggests that the reason of low effectiveness may be due to a strategy focused on symptoms, without considering their origin. Method: The aim of study was the comparison of retrospective data from 535 women with venous disease, either after treatment (n = 183) or not treated before (n = 352). The analysis concerned clinical symptoms and the results of the extended diagnostics, including the examination of the lower limb, pelvic and abdominal veins either using duplex-doppler ultrasound as well as venography with computed tomography or magnetic resonance. Results: The comparison of selected venous system parameters revealed more advanced disease progression in previously treated patients, compared to non-treated individuals (e.g., ipsi- or bilateral incompetence of sapheno-phemoral junction—29.5% vs. 20.4%, at P < 0.05 and 13.6% vs. 7.7% at P < 0.05, respectively). This difference could be explained by post-treatment alterations in the venous system, an older age and the higher number of pregnancies in the recurrence group. However, both groups did not differ in regards to the symptoms of pelvic venous insufficiency or the frequency of relevant variants/abnormalities in venous system. Conclusions: Based on the aforementioned findings, we postulate the revision of treatment strategy, which should consider abdominal and pelvic veins as the source of reflux in many female subjects.

Hemodynamic and Radiological Classification of Ovarian Veins System Insufficiency

“…For this purpose, a retrospective analysis of the results of various imaging examinations was performed, including venous color-duplex ultrasound (CDU), intravascular ultrasound (IVUS), magnetic resonance venography (MRV), computed tomographic venography (CTV) and digital phlebography results collected in the database of our clinic. In the light of our recent studies [8], growing evidence indicates that PVI resulting from the incompetence of the ovarian veins is responsible in part for primary venous insufficiency of the lower extremities, as well as for the formation of recurrent varicose veins. As we know from the latest literature of patients with recurrent varices of the lower extremities, PVI is found in over half of studied women [7][8][9][10][11][12][13].…”

The Number of Pregnancies and Deliveries and Their Association with Selected Morphological and Hemodynamic Parameters of the Pelvic and Abdominal Venous System

“…Considering this, a few authors have proposed scleroembolization of pelvic veins in selective cases of varices in the lower limbs [18,19]. These cumulative data reinforce the need to take into consideration also the likelihood of PVI in the diagnostic and therapeutic approach to lower limb varicose veins [18,19,21].…”

“…The link between pregnancy, PVI, and the manifestation of varicose veins in the lower limbs has been emphasized in a few publications concerning recurrent varicose veins [21][22][23][24][25]. Venographic studies using either computed tomography or magnetic resonance imaging play a key role in that research.…”

“…It may also be a consequence of impaired outflow due to some inborn venous anomalies. The latter include various anatomical abnormalities of LRV (mainly its entrapment between the aorta and the superior mesenteric artery, also known as the "nutcracker" phenomenon, or LRV compression due to its retroaortic location), as well as some LOV anomalies, usually concerning atypical blood drainage (into accessory renal veins, or even independent of LRV) [21]. Each of the aforementioned factors, as well as some other venous irregularities (e.g., concerning iliac veins), may be sufficient to overload ovarian and/or parauterine veins.…”

“…Each of the aforementioned factors, as well as some other venous irregularities (e.g., concerning iliac veins), may be sufficient to overload ovarian and/or parauterine veins. Then, the overstrained PUV may further propagate the reflux through perineal connections-so-called leakage points-to the lower limb venous system [19,21,24].…”