Hasta Pozisyonunun Alt Ekstremite Varislerinin Duplex Ultrason Bulguları Üzerindeki Etkisi

Abstract

Amaç: Kronik venöz yetmezlik (KVY), alt ekstremitelerdeki kapak disfonksiyonuna bağlı venöz hipertansiyon ile karakterize yaygın bir durumdur. Doppler ultrason (DUS), özellikle venöz morfoloji ve reflü değerlendirmesi için varislerin tanısında tercih edilen görüntüleme yöntemidir. Ancak, optimal hasta pozisyonu konusunda bir fikir birliği yoktur. Bu çalışma, hasta pozisyonunun venöz yetmezliği tespit etmede DUS’un doğruluğu üzerindeki etkisini incelemektedir. Yöntem: Bu retrospektif çalışmaya hem supin hem de ayakta pozisyonda DUS yapılan 72 hasta (126 ekstremite) dahil edildi. Büyük safen ven (GSV) ve küçük safen ven (SSV) çapları ile reflü süreleri ven boyunca çeşitli noktalarda ölçüldü. Veriler, hasta pozisyonunun varislerin görünürlüğü ve reflü tespiti üzerindeki etkisini belirlemek için analiz edildi. Bulgular: Ayakta pozisyon, supin pozisyona kıyasla GSV ve SSV çaplarında ve varislerin görünürlüğünde anlamlı derecede artış sağladı. Reflü, özellikle distal uylukta, ayakta pozisyonda daha belirgindi. İki pozisyon arasında safenofemoral bileşkedeki reflüde anlamlı bir fark gözlenmedi, ancak ayakta pozisyon distal uyluktaki reflü tespitini artırdı. Sonuç: Hasta pozisyonu, KVY için DUS değerlendirmelerinin doğruluğunu önemli ölçüde etkiler. Ayakta pozisyon venöz yetmezlik tespitini artırırken, supin pozisyon özellikle ayağa kalkamayan hastalarda geçerliliğini korur. Her iki pozisyonun birlikte kullanılması, varislerin değerlendirilmesinde tanısal doğruluğu ve hasta sonuçlarını iyileştirebilir.

Keywords

• duplex ultrason
• varis
• venöz reflü
• alt ekstremite
• hasta pozisyonu

EFFECT OF PATIENT POSITION ON HEMODYNAMIC AND ANATOMICAL ASSESSMENT OF LOWER-LIMB VARICOSE VEINS USING DUPLEX ULTRASONOGRAPHY

Abstract

Objective: To evaluate the effect of patient positioning on duplex ultrasound (DUS) findings in lower-extremity varicose veins, with particular emphasis on changes in saphenous vein diameter and reflux detection between the supine and standing positions. Methods: This retrospective study included 72 patients involving 126 extremities who underwent DUS for suspected venous insufficiency between January and May 2019. Adult patients with primary varicose veins and no history of venous surgery were included, whereas those with a history of deep vein thrombosis, pregnancy, active skin infection, or significant peripheral arterial disease were excluded. All examinations were performed using a Toshiba Aplio 500 ultrasound system equipped with a 14–7.2 MHz linear-array transducer. DUS examinations were performed by two radiologists, each with more than five years of experience in vascular ultrasonography. Great saphenous vein (GSV) diameters were measured at the saphenofemoral junction and distal thigh, and small saphenous vein (SSV) diameter was measured at the saphenopopliteal junction. Reflux times were assessed in the GSV at the saphenofemoral junction and distal thigh in both positions. Pathological reflux was defined as retrograde flow lasting ≥0.5 s. Statistical analyses were performed using Student’s t-test, the Mann–Whitney U test, and the chi-square or Fisher’s exact test, as appropriate. A p value <0.05 was considered statistically significant. Results: Compared with the supine position, standing examination showed significantly larger GSV and SSV diameters (p<0.001 for all) and improved visualization of varicose veins (p<0.05). Reflux prevalence at the saphenofemoral junction increased slightly from 72.3% to 78.6%, without statistical significance (p=0.24), whereas reflux at the distal thigh increased significantly from 17.5% to 37.3% (p<0.001). Conclusion: Standing examination increases saphenous vein caliber and improves reflux detection, particularly in distal segments, and should therefore be used for pre-interventional reflux mapping whenever feasible.

Keywords

• Duplex Ultrasound
• Great saphenous vein
• Patient Position
• Varicose veins
• Venous Reflux

References

1. Maurins U, Hoffmann BH, Lösch C, Jöckel KH, Rabe E, Pannier F. Distribution and prevalence of reflux in the superficial and deep venous system in the general population: Results from the Bonn Vein Study, Germany. J Vasc Surg. 2008;48(3):680-687. doi:10.1016/j.jvs.2008.04.029.
2. Jeanneret C, Jäger KA, Zaugg CE, Hoffmann U. Venous reflux and venous distensibility in varicose and healthy veins. Eur J Vasc Endovasc Surg. 2007;34(2):236-242. doi:10.1016/j.ejvs.2007.03.018.
3. Khilnani NM. Duplex ultrasound evaluation of patients with chronic venous disease of the lower extremities. AJR Am J Roentgenol. 2014;202(3):633-642. doi:10.2214/AJR.13.11465.
4. Depopas E, Brown M. Women’s health: Varicose veins and lower extremity venous insufficiency. Semin Intervent Radiol. 2018;35(1):56-61. doi:10.1055/s-0038-1636522.
5. Houle M, Neuhardt DL, Straight NT, Salles-Cunha SX. Differences in saphenous vein reflux detection according to patient positioning. J Vasc Ultrasound. 2018;37(2):81-84. doi:10.1177/154431671303700205.
6. Kelly D, Scovell S. Standardizing practice patterns for venous insufficiency ultrasound. Phlebology. 2025;40(2):126-132. doi:10.1177/02683555241276556.
7. Joh JH, Park HC. The cutoff value of saphenous vein diameter to predict reflux. J Korean Surg Soc. 2013;85(4):169-174. doi:10.4174/jkss.2013.85.4.169.
8. Kim MJ, Park PJ, Koo BH, Lee SG, Byun GY, Lee SR. Association between venous reflux and diameter of great saphenous vein in lower thigh. J Vasc Surg Venous Lymphat Disord. 2020;8(1):100-105. doi:10.1016/j.jvsv.2019.04.016.

9. Zalaquett E, Gunabushanam G, Vallejos A, Dahiya N. Ultrasound evaluation of chronic venous insufficiency. Ultrasound Q. 2023;39(1):2-9. doi:10.1097/RUQ.0000000000000634.
10. Gloviczki P, Lawrence PF, Wasan SM, et al. The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II: Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine. J Vasc Surg Venous Lymphat Disord. 2024;12(1):101670. doi:10.1016/j.jvsv.2023.08.011.
11. Harrison G. Peripheral vascular ultrasound. How, why and when. 2nd ed. A. Thrush, T. Hartshorne. Radiography. 2005;11:230. doi:10.1016/j.radi.2005.02.007.
12. Adler C, Mousa A, Rhee A, Patel MD. Varicose veins of the lower extremity: Doppler US evaluation protocols, patterns, and pitfalls. Radiographics. 2022;42(7):2184-2200. doi:10.1148/RG.220057.
13. Choi JY, Lee JH, Kwon OJ. Association between the saphenous vein diameter and venous reflux on computed tomography venography in patients with varicose veins. PLoS One. 2022;17(2):e0263513. doi:10.1371/journal.pone.0263513.
14. Mendoza E, Blättler W, Amsler F. Great saphenous vein diameter at the saphenofemoral junction and proximal thigh as parameters of venous disease class. Eur J Vasc Endovasc Surg. 2013;45(1):76-83. doi:10.1016/j.ejvs.2012.10.014.
15. De Morais Filho D, de Oliveira RG, Engelhorn CA, Salles-Cunha SX. Vascular ultrasound exam for varicose veins: Importance of patient positioning. Ann Vasc Med Res. 2017;4(2):1051.
16. DeMuth RP, Caylor K, Walton T, et al. Clinical significance of standing versus reversed Trendelenburg position for the diagnosis of lower-extremity venous reflux in the great saphenous vein. J Vasc Ultrasound. 2012;36(1):19-22. doi:10.1177/154431671203600103.
17. Cairnduff M, Swan H, Barton B, Buckley AR. Assessing the variable of patient positioning when examining the lower limb veins for reflux using spectral and colour Doppler ultrasound. Australas J Ultrasound Med. 2007;10(3):22-28.
18. Carty GA, Steele JL, Clemens J. Standing versus supine evaluation for superficial venous reflux. J Vasc Ultrasound. 2013;37(3):119-124. doi:10.1177/154431671303700301.