Venous Structural Angulations and their Relationship with Insufficiency
DOI:
https://doi.org/10.12974/2313-0954.2015.02.01.4Keywords:
Chronic venous disease, doppler ultrasonography, venous angulation.Abstract
Objective: The venous insufficiency of lower limb is a common complaint in the population. The natural history of CVD is not clear enough to satisfy. We have investigated the venous anatomy and reflux existence of the lower limb by using the structural angulations of the venous outlets and related this to the occurrence of venous reflux in the superficial, deep and perforator venous system, demonstrated on CDS.
Methods: We investigate 44 limbs of 22 healthy subjects and 46 limbs of 23 patients with chronic venous disease (CVD). The participants were evaluated with duplex scanning for venous reflux. The CDS examination performed in the upright and supine position. Compression on gray-scale and color Doppler were employed to assess the absence of venous thrombosis.
Result: 45 patients (31 female, 14 male) were examinated on doppler ultrasonography. The mean age was 54.5 years (41 to 79 years). All subjects were in normal range of body-mass-index and had no significant disease. We measured the vascular angulations on gray-scale ultrasonography. The measured the angulations of common femoral vein-saphenofemoral junction, saphenofemoral junction-vena saphena magna, common femoral vein-superficial femoral vein, common femoral vein-deep femoral vein and bifurcation of superficial femoral vein-deep femoral vein, respectively. Anatomical structural angulations were measured at 5 levels on sonography.
Conclusion: The CDS is a definitive, economical and noninvasive safe diagnostic method in the diagnosis of CVD. This method appears to suggest a new imaginative approach with the measure of the angulations between venous vessel connections, consequently may predictive further CVD in early periods.
References
Cina A, Pedicelli A, Di Stasi C, Porcelli A, et al. Color- Doppler sonography in chronic venous insufficiency. What the radiologist should know. Curr Probl Diagn Radiol 2005; 34(2): 51-62. http: //dx.doi.org/10.1067/j.cpradiol.2004.12.001
Brand FN, Dannenberg AL, Abbott RD, Kannel WB. The epidemiology of varicose veins: the Framingham Study. Am J Prev Med 1988; 4(2): 96-101.
Labropoulos N, Leon LR Jr. Duplex evaluation of venous insufficiency. Semin Vasc Surg 2005; 18(1): 5-9. http: //dx.doi.org/10.1053/j.semvascsurg.2004.12.002
Labropoulos N, Tiongson J, Pryor L, Tassiopoulos AK, et al. Definition of venous reflux in lower-extremity veins. J Vasc Surg 2003; 38(4): 793-8. http: //dx.doi.org/10.1016/S0741-5214(03)00424-5
Rosfors R, Bygdeman S, Nordstrom E. Assessment of deep venous incompetence: a prospective study comparing duplex scanning with descending phlebography. Angiology 1990; 41(6): 463-8. http: //dx.doi.org/10.1177/000331979004100607
Kurt A, Unlu UL, Ipek A, Tosun O, et al. Short saphenous vein incompetence and chronic lower extremity venous disease. J Ultrasound Med 2007; 26(2): 163-7.
Rueda CA, Bittenbinder EN, Buckley CJ, Bohannon WT, Atkins MD, Bush RL. The management of chronic venous insufficiency with ulceration: the role of minimally invasive perforator interruption. Ann Vasc Surg 2013; 27(1): 89-95. http: //dx.doi.org/10.1016/j.avsg.2012.09.001
Labropoulos N, Leon L, Kwon S, Tassiopoulos A, et al. Study of the venous reflux progression. J Vasc Surg 2005; 41(2): 291-5. http: //dx.doi.org/10.1016/j.jvs.2004.11.014
Yamamoto N, Unno N, Mitsuoka H, Saito T, et al. Preoperative and intraoperative evaluation of diameter-reflux relationship of calf perforating veins in patients with primary varicose veins. J Vasc Surg 2002; 36(6): 1225-30. http: //dx.doi.org/10.1067/mva.2002.128941
Sandri JL, Barros FS, Pontes S, Jacques C, Salles-Cunha SX. Diameter-reflux relationship in perforating veins of patients with varicose veins. J Vasc Surg 1999; 30(5): 867- 74. http: //dx.doi.org/10.1016/S0741-5214(99)70011-X
Labropoulos N, Kang SS, Mansour MA, Giannoukas AD, Buckman J, Baker WH. Primary superficial vein reflux with competent saphenous trunk. Eur J Vasc Endovasc Surg 1999; 18(3): 201-6. http: //dx.doi.org/10.1053/ejvs.1998.0794
Kistner RL. Definitive diagnosis and definitive treatment in chronic venous disease: a concept whose time has come. J Vasc Surg 1996; 24(5): 703-10. http: //dx.doi.org/10.1016/S0741-5214(96)70001-0