Hasta Pozisyonunun Alt Ekstremite Varislerinin Duplex Ultrason Bulguları Üzerindeki Etkisi

Öz

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.

Anahtar Kelimeler

• 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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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