Chronic venous insufficiency patterns in lower extremity veins detected by Doppler Ultrasound

Öz

Objective: The aim of this study was to reveal patterns of chronic venous insufficiency of lower extremity detected by color Doppler ultrasound and clarify its clinical implications in the patients with varicose veins symptoms. Methods: Between 2006 to 2011, a total of 2006 patients presented with symptoms of venous insufficiency were included in study. A total of 3938 lower extremity venous systems were examined using color Doppler US. We classified four patterns considering combinations of superficial and deep venous insufficiency. Results: Of 2006 patients, 966 had either single venous insufficiency (790, 82%) or combined insufficiency (176, 18%). Superficial venous insufficiency was observed at the saphenoefemoral junction (SFJ) in 25.5%, at the Great Saphenous Vein (GSV) in 57.6%, at the Giacomini Vein in 2.4%, at the saphenopopliteal junction in 1.8% and finally at the Small Saphenous Vein (SSV) in 9.1% of the patients. We found multilevel venous insufficiency showing connections at the rate of 51%. We described four patterns as Pattern 1: SFJ insufficiency combined with GSV (97.9%), GSV branching (7.1%), and perforating vein (20.8%) insufficiency, Pattern 2: Deep venous insufficiency combined with SFJ (63.6%), GSV (76.4%), and SSV (16.4%) insufficiency, Pattern 3: SPJ insufficiency combined with SSV insufficiency (95.5%) and Pattern 4: Giacomini Vein insufficiency combined with GSV (67.9%) and SSV (75%) insufficiency. Conclusion: Chronic venous insufficiency may show four different patterns. Our results revealed that SFJ and GSV insufficiency combination and deep venous insufficiency and GSV insufficiency combinations are the most common insufficiency patterns seen in lower extremity.

Anahtar Kelimeler

• Doppler ultrasound, varicose veins, venous insufficiency

Alt ekstremitede Doppler ultrasonografi ile tespit edilen kronik venöz yetmezlik tipleri

Öz

Amaç: Bu çalışmada, varis şikayeti olan hastalarda Doppler US ile alt ekstremite de tespit edilen kronik venöz yetmezliğinin paternlerinin ve klinik öneminin ortaya konması amaçlanmıştır. Yöntem: Venöz yetmezlik semptomu olan 2006 hasta çalışmaya dahil edilmiştir.Doppler US inceleme yapılan toplam 3938 alt ekstremite venöz sistemi incelenmiştir. Araştırmada yüzeyel ve derin venöz yetmezlik kombinasyonu gösteren dört patern klasifiye edilmiştir. Sonuçlar: İnceleme yapılan 2006 hastanın, 966\'sında ya tek venöz yetmezlik seviyesi (790, %82) ya da yetmezlik kombinasyonu (176, %18) saptanmıştır. Yüzeyel venöz yetmezlik, %57,6 Vena Safena Manga (VSM), %25,5 safenofemoral bileşke (SFB), %9,1 Vena Safena Parva (VSP), %2,4 Giacomini Veni, %1,8 safenopopliteal bileşke (SPB) seviyesinde karşımıza çıkmıştır. Yetmezlik gösteren hastalar arasında %51 oranında çoklu seviye yetmezlik kombinasyonları saptanmıştır. Bu kombinasyonlar dört patern olarak açıklanmıştır. Patern 1: SFB ile VSM (%97,9), VSM\'nın dallarının (%7,1) ve perforan venlerin (%20,8) birlikteliği. Patern 2: Derin venöz yetmezliğin, SFB (%63,6), VSM (%76,4), ve VSP (%16,4) ile kombinasyonu. Patern 3: SPB yetmezliğinin VSP (%95,5) ile birlikteliği. Patern 4: Giacomini Ven yetmekliğinin VSM (%67,9) ve VSP (%75) ile kombinasyonu. Tartışma: Kronik venöz yetmezlik dört patern olarak karşımıza çıkabilir. Sonuçlarımız özellikle SFB ile VSM ve derin venöz sistem ile VSM yetmezlik birlikteliğinin çok sık olduğunu ortaya koymaktadır.

Anahtar Kelimeler

• Doppler ultrasonografi, variköv ven, venöz yetmezlik.

Kaynakça

1. Scurr JH, Tibbs DJ. Varicose veins and venous disorders. In: Tibbs DJ (ed) Varicose veins, Venous disorders, and lymphatic problems in the lower limbs. Oxford University Press, Oxford, 1997; 3-20.
2. Sumner DS. The hemodynamics and pathophysiology of venous diseases. Vascular surgery. Philadelphia: WB Saun- ders 1977: 147-161.
3. Agus GB, Allegra C, Antignani PL, et al. Guidelines for the diagnosis and treatment of chronic venous disorders. Inter- national Angiology; 2005;24:107-168.
4. Cina A, Pedicelli A. Color-Doppler Sonography in Chronic Venous Insufficiency: What the Radiologist Should Know. Curr Probl Diagn Radiol 2005; 34:51-62.
5. Campbell WB, Halim AS, Aertssen A, Ridler BM, Thomp- son JF, Niblett PG. The place of duplex scanning for vari- cose veins and common venous problems. Ann R Coll Surg Engl. 1996;78:490-493.
6. Dixon PM. Duplex ultrasound in the pre-operative assess- ment of varicose veins. Australas Radiol 1996; 40:416-421.
7. Yilmaz, S. Yeni tedaviler isiginda alt ekstremite yuzeyel ve- noz Doppler US incelemesi. Turkrad 2007;177-184.
8. Thorisson HM, Pollak JS, Scoutt L. The role of ultrasound in the diagnosis and treatment of chronic venous insuffi- ciency. Ultrasound Quarterly 2007;23:137-150.

9. Min RJ, Khilnani NM, Golia P. Duplex Ultrasound Evalua- tion of Lower Extremity Venous Insufficiency, J Vasc Interv Radiol 2003;14:1233-1241.
10. Labropoulos N. Definition of venous reflux in lower-ex- tremity veins. Journal of Vascular Surgery 2003;38:793- 798.
11. Tibbs, D Sabiston, P Mortimer, M Davis. Varicose Veins, Venous Disorders, and Lymphatic Problems in the Lower Limbs DJ J Scurr Oxford University Press, USA 1997.
12. Allegra C, Carlizza A. Oedema in chronic venous insuf- ficiency: Pathophysiology and investigation. Phlebology 2000; 15:122-125.
13. Tibbs DJ, Sabiston D, Mortimer P, et al. Varicose Veins, Venous Disorders, and Lymphatic Problems in the Lower Limbs, 1997 - Oxford University Press, USA.
14. Sobaszek A, Frimat P, Tiberguent A, et al. Venous insuffi- ciency of the lower limbs and working conditions. Phlebol- ogy 1998; 13:133-141.
15. Bradbury A, Evans C, Allan P, et al. What are the symptoms of varicose veins? Edinburgh vein study cross sectional population survey. BMJ 1999; 318:353-356.
16. Giuliano A The Fundamentals Of Phlebology: Venous Dis- ease for Clinicians 2nd edition, London 2007.
17. Campbell WB, Decaluwe H, MacIntyre J, et al. Most pat- ents with varicose veins have fears or concerns about the future, in addition to their presenting symptoms. Eur J Vasc Endovasc Surg 2006; 31:332-334.
18. Sindel T, Apaydin A, Soke B, Luleci E. Derin ven trombozu tanısında ultrasonografinin degeri, Radyoloji ve Tibbi Go- runtuleme Dergisi 1992;2:95-99.
19. Lewis BD. Diagnosis of acute deep venous thrombosis of the lower extremities: prospective evaluation of col- or doppler flow imaging versus venography. Radiology 1994;192:651-655.
20. Evans CJ, Fowkes FG, Hajivassiliou CA, Harper DR & Ruckley V. Epidemiology of varicose veins. A review. Int Angiol 1994;13:263-270.
21. Lee AJ, Evans CJ, Allan PL, et al. Lifestyle factors and the risk of varicose veins. J Clin Epidemiol 2003;56:171-179.