Predictive value of a day orthostatic loading test for the reversibility of the great saphenous vein reflux after phlebectomy of all varicous tributaries.

Abstract

The aim of this study was to evaluate predictive value of a day orthostatic loading test (DOL-test) for the reversibility of the great saphenous vein (GSV) reflux after phlebectomy of all varicose tributaries (VTs). Prospective cohort study. Patients with reflux in the GSV were included. Patients were treated by phlebectomy for all VTs of the GSV. GSV reflux was measured during a Duplex ultrasound examination with DOL-based on: 1) reflux location and donor vein; 2) reflux extent (RE) of the GSV was evaluated according to the number of zones of reflux (NZR) which included three thigh and three calf zones; 3) reflux duration (RD); 4) peak reflux velocity (PRV) in GSV reflux point of initiation; 5) the diameter of the GSV; 6) orthostatic gradient (OG) - difference between evening and morning values of the GSV diameter. We included 87 lower limbs (LLs) in 65 patients (51 women and 15 men) aged from 29 to 53 (mean age 36.7) years. In twelve months after the surgery the amount of limbs with eliminated reflux constituted 77.0%. In LLs with incompetence of SFJ the reversibility of the GSV was observed in 59.0% of cases in 12 months after treatment. В LLs without incompetence of SFJ the reversibility constituted 91.7%. In LLs with resolved GSV reflux (N.=67) the initial evening RE constituted 3.76 and reduced in the morning to 1.51, P=0.000001. In LLs with persistent GSV reflux (N.=20) the initial evening RE constituted 3,75 and reduced in the morning to 3.00, P=0.028418. In LLs with resolved GSV reflux the initial evening RD constituted 2.10 s and reduced in the morning to 0.93 s, P=0.000001. In LLs with persistent GSV reflux the initial evening RD constituted 2.13 s and reduced in the morning to 1.82 s, P=0.043115. In LLs with resolved GSV reflux the initial evening PRV constituted 173.46 mm/s and reduced in the morning to 101.57 mm/s, P=0.000001. In LLs with persistent GSV reflux the initial evening PRV constituted 172.50 mm/ and reduced in the morning to 158.50 mm/s, P=0.007686. In LLs with resolved reflux the initial OG was 0.93 mm with the initial evening GSV diameter of 7.20 mm. After the surgery OG reduced to 0.59 mm, P=0.000001. The evening vein diameter decreased to 5.07 mm, P=0.000001. In LLs with persistent reflux the OG and the GSV diameter decreased from 0.55 mm to 0.51 mm, P=0.017961 and evening GSV diameter from 7.75 mm initially to 7.55 mm after the treatment, P=0.067890 respectively. Characterizing GSV with minimum volume loading, DOL-test shows the degree of preservation of muscular-tonic properties of GSV and allows to predict the reversibility of the GSV reflux after phlebectomy. Being initially high, the GSV OG points that the potential of muscular-tonic function is saved. Its decrease after the surgery proves the decrease of the volume loading on GSV.