Quantification of Hemodynamic Parameters in Primary Great Saphenous Reflux using Colour Doppler in Clinical Settings and Effect of GSV Ablation on the Venous Arterial Flow Index

Abstract

Purpose: The aim of our study was to quantify venous reflux in outpatient settings using color Doppler and document objective improvement in hemodynamic parameters post ablation. Methods: Venous reflux was measured using color Doppler using venous-arterial flow index (VAFI), recirculation index (RCI), and percentage diameter change (PDC) (n = 30) and compared with healthy volunteers (n = 30), adjusted for age, sex, and body mass index (BMI). Patients with concomitant peripheral arterial disease (PAD), past history of deep venous thrombosis, chronic venous insufficiency, and venous ulcers were excluded from the study. Patients with reflux underwent RFA and VAFI was measured 6 months after treatment. Data were analyzed using IBM SPSS statistics software version 25. Tests of normality were applied before choosing statistical tests. Box-and-whisker plots with outliers were used to illustrate the difference between case and control groups. VAFI scores were compared pre- and postoperatively and Wilcoxon signed-rank test was applied for the comparison. P < 0.05 defined statistical significance. Results: Thirty patients with primary GSV reflux along with 30 healthy volunteers were adjusted for age, sex, and BMI. Clinical part of CEAP classification was C0 = 2, C1 = 6, C2 = 16, and C3 = 6 in reflux group and C0 = 26 and C1 = 4 in (n = 30) in healthy volunteers. There was a statistical difference in RCI, PDC, and VAFI across both groups (P < 0.5). In addition, VAFI decreased significantly after treatment at 6 months (1.38 preoperative to 0.95 postoperative, SD P < 0.5). Of the 30 patients, 21 had pain as the primary presenting symptom; 81% (17) reported a significant decrease in pain scores associated with hemodynamic improvement. Conclusion: RCI, PDC, and VAFI are accurate quantitative measurements of reflux in outpatient settings. VAFI is useful in objectifying the results of treatment. Symptomatic improvement in terms of pain score can be used to supplement the hemodynamic improvement though further substantiation of the above would be required in a larger cohort.