The Influence of Body Mass Index on Lower Extremity Vein Diameters at Different Levels in Healthy Population

Year 2021, , 107 - 114, 05.05.2021

Isil Yildiz , Demet Gündüz

https://doi.org/10.47482/acmr.2021.23

Abstract

Background: To investigate changes in the size of the deep and superficial venous systems associated with body mass index (BMI), gender, age, in patients without venous insufficiency including the effects of posture.

Methods: Healthy individuals who had no previous diagnosis of venous insufficiency were evaluated with an ultrasound device with a duplex option. The left and right deep and superficial venous systems were scanned both supine and upright positions by the same two radiologists. All clinical findings, BMI and age were recorded for each subject.

Results: Two-hundred ninety-eight patients were included in the study. The patients’ mean age and BMI were 49.94 ±13.19 years (range 19-76), BMI was 24.91±4.0 kg/m² (range 18-38) respectively. The difference between upright and supine positions vein diameters were statistically significant (p<0.01). There were no significant differences between overweight and normal participants in terms of femoral and saphenous vein diameters (p>0.05). The proximal diameter of the great saphenous vein was significantly lower in overweight patients (Table 2). When the patients were analyzed according to BMIs the right femoral vein diameters, the diameters of proximal part and distal two parts of the right great saphenous vein, and left proximal small saphenous vein diameters were significantly higher in patients whose BMI values were between 35-39.99 (obese-class II) (p<0.001).

Conclusions: In conclusion we found both lower limbs’ vein diameters were significantly larger in upright position either superficial and deep systems, however the relationship between age and BMI was not significant. Further longitudinal studies are needed to clarify the influence of anatomic variances in subjects with obese healthy veins.

Keywords

Chronic Venous Disease, Risk Factors, Age, Obesity, Lower Extremity, Vein Diameter.

References

• 1. Robertson L, Evans C, Fowkes FG. Epidemiology of chronic venous disease. Phlebology. 2008;23(3):103-11.
• 2. Chiesa R, Marone EM, Limoni C, Volontè M, Petrini O. Chronic venous disorders: correlation between visible signs, symptoms, and presence of functional disease. J Vasc Surg. 2007;46(2):322-30.
• 3. Darvall KA, Sam RC, Silverman SH, Bradbury AW, Adam DJ. Obesityand thrombosis. Eur J Vasc Endovasc Surg. 2007;33(2):223-33.
• 4. Padberg F Jr, Cerveira JJ, Lal BK, Pappas PJ, Varma S, Hobson RW 2nd. Does severe venous insufficiency have a different etiology in the morbidly obese? Is it venous? J Vasc Surg. 2003;37(1):79-85.
• 5. Arfvidsson B, Eklof B, Balfour J. Iliofemoral venous pressure correlates with intraabdominal pressure in morbidly obese patients. Vasc Endovascular Surg. 2005;39(6):505-9.
• 6. Kröger K, Ose C, Rudofsky G, Roesener J, Weiland D, Hirche H. Peripheral veins: influence of gender, body mass index, age and varicose veins on cross-sectional area. Vasc Med. 2003;8(4):249-55.
• 7. Keiler J, Schulze M, Claassen H, Wree A. Human femoral vein diameter and topography of valves and tributaries: A post mortem analysis. Clin Anat. 2018;31(7):1065-1076.
• 8. WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253.
• 9. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157-63.
• 10. Adhikari A, Criqui MH, Wooll V, Denenberg JO, Fronek A, Langer RD, et al. The epidemiology of chronic venous diseases. Phlebology. 2000;15(1):2-18.
• 11. Ageno W, Piantanida E, Dentali F, Steidl L, Mera V, Squizzato A, et al. Body mass index is associated with the development of the postthrombotic syndrome. Thromb Haemost. 2003;89(2):305-9.
• 12. Danielsson G, Eklof B, Grandinetti A, Kistner RL. The influence of obesity on chronic venous disease. Vasc Endovascular Surg. 2002;36(4):271-6.
• 13. Hansson PO, Eriksson H, Welin L, Svardsudd K, Wilhelmsen L. Smoking and abdominal obesity: risk factors for venous thromboembolism among middle-aged men: “the study of men born in 1913.” Arch Intern Med. 1999;159(16):1886-90.
• 14. Kugler C, Strunk M, Rudofsky G. Venous pressure dynamics of the healthy human leg. Role of muscle activity, joint mobility and anthropometric factors. J Vasc Res. 2001;38(1):20-9.
• 15. Amélia C. Seidel, Fausto Miranda Jr., Yara Juliano, Neil F. Novo Relationship between the diameter of great saphenous vein and body mass index. J Vasc Bras. 2005;4(3):265-9.
• 16. Monahan KD, Dinenno FA, Seals DR, Halliwill JR. Smaller ageassociated reductions in leg venous compliance in endurance exercisetrained men. Am J Physiol Heart Circ Physiol. 2001;281(3):H1267-73.
• 17. Smit AAJ, Halliwil JR, Low PA, Wieling W. Pathophysiological basis of orthostatic hypotension in autonomic failure. J Physiol. 1999;519 Pt 1(Pt 1):1-10.
• 18. Burke D, Sundlo¨f G, Wallin BG. Postural effects on muscle nerve sympathetic activity in man. 1977;272(2):399-414.
• 19. Tullis MJ, Meisner MH, Bergelin RO, Caps MT, Manzo RA, DE Strandness. The relationship of venous diameter to reflux, cephalad thrombus and cephalad reflux following deep venous thrombosis. Thromb Haemost. 1997;77(3):462-5.
• 20. Willenberg T, Schumacher A, Amann-Vesti B, Jacomella V, Thalhammer C, Diehm N, Baumgartner I, Husmann M. Impact of obesity on venous hemodynamics of the lower limbs. J Vasc Surg. 2010;52(3):664-8.
• 21. Rabe E, Pannier F. What have we learned from the Bonn Vein Study? Phlebolymphology. 2006;13:188-194
• 22. Abdollahi M, Cushman M, Rosendaal FR. Obesity: risk of venous thrombosis and the interaction with coagulation factor levels and oral contraceptive use. Thromb Haemost. 2003;89(3):493
• 23. Goldhaber SZ, Grodstein F, Stampfer MJ, Manson JE, Colditz GA, Speizer FE, et al. A prospective study of risk factors for pulmonary embolism in women. JAMA. 1997;277(8):642-5.
• 24. Stein PD, Beemath A, Olson RE. Obesity as a risk factor in venous thromboembolism. Am J Med. 2005;118(9):978-80.
• 25. Eichinger S, Hron G, Bialonczyk C, Hirschl M, Minar E, Wagner O, et al. Overweight, obesity, and the risk of recurrent venous thromboembolism. Arch Intern Med. 2008;168(15):167883.
• 26. Fronek A, Criqui MH, Denenberg J, Langer RD. Common femoral vein dimensions and hemodynamics including Valsalva response as a function of sex, age, and ethnicity in a population study. J Vasc Surg. 2001;33(5):1050-6.