Abstract
We sought to assess clinical characteristics and pattern of collateral network involvement associated with development of truncal (systematized) versus diffuse/non-truncal (non-systematized) varicose veins (VVs) in patients undergoing endovascular laser photothermolysis for chronic venous insufficiency (CVI). Secondly, we aimed to assess whether the type of VVs influenced the procedural complications of endovascular laser therapy. A total of 508 patients with hydrostatic VVs of the lower limbs who underwent endovenous laser treatment were included, out of which 84.1% (n=427) had truncal VVs (group 1) and 15.9% (n=81) had diffuse (non-systematized) VVs (group 2). Patients with truncal varices were significantly older (47.50±12.80 vs 43.15±11.75 years, P=0.004) and those with associated connective tissue disorders were more prone to present diffuse VVs (P=0.004). Patients in group 1 presented a significantly higher number of Cockett 1 (P=0.0017), Cockett 2 (P=0.0137), Sherman (P<0.0001), and Hunter (P=0.0011) perforator veins compared to group 2, who presented a higher incidence of Kosinski perforators (P<0.0001). There were no significant differences regarding postoperative complications: thrombophlebitis (P=0.773), local inflammation (P=0.471), pain (P=0.243), paresthesia (P=1.000), or burning sensation (P=0.632). Patients with more advanced CEAP (clinical, etiologic, anatomic, pathophysiologic) classes were older (P<0.0001), more were males (39.05 vs 27.77%, P=0.0084), more were prone to present ulcers (P<0.0001) and local hyperthermia (P=0.019), and presented for endovenous phlebectomy after a longer time from symptom onset. In patients with CVI, systematized VVs were associated with a more severe clinical status and a distinct anatomical pattern of perforators network compared to non-systematized VVs, which is more common in advanced stages.
Highlights
Chronic venous insufficiency (CVI) is a common vascular disorder affecting almost one third of the adult population, having a substantial negative impact on healthcare costs and on the health-related quality of life [1,2,3]
Analysis of sex distribution showed that both systematized and non-systematized varicose veins (VVs) were more frequent in females, affected in 65.5% of cases in group 1 and in 96.1% of cases in group 2
We demonstrated that there were significant differences in clinical presentation and anatomical distribution of the perforator network in patients with systematized versus non-systematized VVs
Summary
Chronic venous insufficiency (CVI) is a common vascular disorder affecting almost one third of the adult population, having a substantial negative impact on healthcare costs and on the health-related quality of life [1,2,3]. The prevalence of CVI and varicose veins (VVs) has been shown to vary across geographic locations and between genders, being estimated at approximately 10–15% in male subjects, and around 20–25% in females [4]. Other risk factors for CVI include older age, pregnancy, family history of venous disorders, obesity, and professional environments that require prolonged orthostasis [5,6]. The pathophysiological mechanism of CVI and VVs consists mainly in alteration of venous return, triggered by the incompetence of venous valves or by an intrinsic defect of the vein wall. The hemodynamic changes caused by altered venous return can lead to stasis, blood pooling, and increased venous pressure in the lower limbs [7,8]. Perforator veins, that connect the deep and superficial venous networks, play an important role in the initiation and progression of varicose vein dilatation, as the presence of reflux in the perforator veins leads to increased venous pressure in the Anatomy of varicose veins and endovascular laser ablation superficial venous network, with secondary varicose dilation of superficial veins [9,10]
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