Classification Of Chronic Venous Insufficiency Research Articles

A Study of Chronic Venous Insufficiency in Relation with Body Mass Index and Diameter of Saphenofemoral Junction and Great Saphenous Vein

Introduction: Chronic venous insufficiency (CVI) is a condition that occurs when the venous wall and/or valves in the lower limb veins are not functioning effectively, making it difficult for the blood to return to the heart from the lower limb. Over time, it can lead to pain, swelling, skin changes over the lower limb, and ulcers around the ankles. Some common etiological factors of CVI include obesity, more than 50 years of age, family history of CVI, smoking, and pregnancy. The combination of obesity and other genetic and environmental factors creates a higher risk for the development of CVI. Objective: The objective was to study the relation between body mass index (BMI) and CVI at its various stages using the clinical, etiological, anatomical, and pathophysiologic (CEAP) classification of CVI. In addition, it was to study whether there was a notable increase of diameter seen in saphenofemoral junction and great saphenous vein (GSV) as the BMI increases and in patients of CVI. Materials and Methods: It was a study conducted on 100 consecutive patients; data were collected from the vascular surgery outpatient department where patients presented with venous disease. The grade of the venous disease was recorded using the CEAP criteria. BMI was calculated for each patient. Based on the BMI, the patients were classified into underweight, normal, overweight, and obese. The mean, standard deviation,Pvalue, and percentage of each stage of venous disease in each group were calculated accordingly and studied. Results: A total of 100 patients were undertaken for the study, out of which 78 were male and 22 were female. The clinical stage according to the CEAP criteria, BMI, diameter of the saphenofemoral junction, and diameter of the GSV was recorded for each patient. Clinical stage (CEAP criteria) was discovered to become more advanced as the BMI increased. According to the data, 50% of underweight patients reported of CVI, 53% of normal weight patients reported of CVI, 72% of overweight patients reported of CVI, and 87% of obese patients reported of CVI. Furthermore, it was noted that there was an increase in the diameter of the GSV as the BMI increased, although no change was seen in the diameter of the saphenofemoral junction. Conclusion: Lower limb venous flow parameters differ significantly among normal, overweight, and obese individuals. The CEAP clinical stage of venous disease is more advanced in obese patients than in nonobese patients with comparable anatomical patterns of venous incompetence. This could possibly be a result of raised intra-abdominal pressure leading to greater reflux, increased vein diameter, and venous pressures. In addition, an increase in diameter was noted in the GSV, however no change in diameter was observed at the saphenofemoral junction, as the BMI of the patients increased. Hence, the findings support the mechanical role of abdominal adipose tissue, which may potentially lead to elevated risk for both, venous thromboembolism and CVI.

THE RESULTS OF THE APPLICATION OF LOW-INVASIVE METHODS FOR TREATMENT OF VARICOSE DISEASE

From 2015 to 2019, we performed surgical treatment of 136 patients for varicose veins of the lower extremities, of whom 74 patients were operated on by endovenous laser coagulation, 62 patients were operated on by radiofrequency ablation. The international classification of chronic venous insufficiency (CEAP) was used to distribute patients according to the severity of the disease. The indication for minimally invasive techniques was the presence of vertical reflux along the major and/or minor saphenous vein in combination with horizontal venous reflux in 95 % of cases. To perform radiofrequency ablation, the VNUS ClosureFast technique was used, and to perform endovasal laser obliteration, the «Lika-Hirurg» apparatus generating a wavelength of 1470 nm and radial (circular) light guides. To assess the results and quality of treatment, all patients underwent examination by a doctor with USDG of the operated lower extremity 1, 6 and 12 months after the treatment. Patients completed the Chronic Venous Insufficiency Questionnaire (CIVIQ 20) before surgery and 6 months after treatment. In all 136 patients, pathological venous reflux was not observed. In 2 patients, 6 months after EVLK, when performing ultrasound control in the trunks of the great saphenous vein, segmental recanalization without pathological reflux was determined. The use of radiofrequency ablation and endovasal laser coagulation of veins in the treatment of varicose veins shows positive results, and in most cases better than in classical surgical interventions, which is primarily due to the low trauma. One of the factors is the short duration of the patient's stay in the clinic and its activation immediately after the operation, which allows maintaining the routine of daily life.

Duplex ultrasound findings and clinical classification of lower extremity chronic venous insufficiency in a Thai population

BackgroundThe objective of this study was to evaluate the association between the clinical classification of chronic venous insufficiency and duplex ultrasound findings. MethodsA total of 1010 limbs with clinically suspected chronic venous insufficiency were stratified according to the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification and underwent duplex ultrasound evaluation consecutively between January 2012 and June 2015. Venous thrombosis, venous reflux, and anatomic distribution of the deep and superficial venous systems were investigated across the CEAP clinical classes. ResultsThere were 259 male limbs (25.6%) and 751 female limbs (74.4%) in clinical class C0 (24 limbs [2.4%]), C1 (130 limbs [13.1%]), C2 (452 limbs [44.8%]), C3 (183 limbs [18.1%]), C4 (163 limbs [16.1%]), C5 (31 limbs [3.1%]), and C6 (27 limbs [2.7%]). The mean age in clinical class C4-C6 (60.77 ± 14.67 years) was statistically significantly higher than in C0-C3 (55.73 ± 18.85 years; P < .001). Male limbs were shown to have a predilection for presenting with clinical class C4-C6 over female limbs (36.3% vs 16.9%; odds ratio, 2.8; 95% confidence interval, 2.0-3.8). Positive findings were predominantly displayed in clinical class C4-C6 compared with C0-C3 (deep venous thrombosis, 3.2% vs 1.3%; deep venous reflux, 30.8% vs 26.9%; superficial vein thrombosis, 2.7% vs 2.0%; superficial venous reflux, 56.6% vs 47.6%; perforator vein reflux, 12.7% vs 8.2% [P = .049]). A low prevalence of small saphenous vein and perforator vein reflux in C1 limbs (0.3% and 4.6%) and C3 limbs (3.8 and 6.6%) was discovered. ConclusionsThe prevalence of CEAP class C0-C3 was found to be higher than C4-C6. However, men were shown to have a predilection for presenting in clinical class C4-C6 over women. The mean age of patients with clinical class C4-C6 limbs was statistically significantly higher than of those with clinical class C0-C3 limbs. The prevalence of deep venous reflux, superficial venous reflux, and coincident deep and superficial venous reflux in clinical class C4-C6 limbs was higher than in clinical class C0-C3 limbs. Detection of incompetent perforator veins was shown to have a statistically significant correlation with clinical class C4-C6 limbs.

The Role of Ultrasound in the Diagnosis and Treatment of Chronic Venous Insufficiency

Chronic venous insufficiency (CVI) is an exceedingly common and underdiagnosed disorder with a wide range of symptoms and prognosis ranging from cosmetic issues to skin ulceration with tissue loss. Ultrasound plays a pivotal role in the diagnosis, classification, and guidance of percutaneous treatment of CVI. It is therefore of critical importance to the practicing radiologist to have a sound understanding of the pathophysiology, pertinent venous anatomy, and classification of CVI. We review the superficial and deep venous anatomy of the lower extremity, introduce a pattern recognition approach for mapping of varicosities, and review the protocol for ultrasound evaluation for CVI. In addition, we discuss the pathophysiology of CVI and the role of ultrasound in guidance for and follow-up of percutaneous treatment.

Classification of chronic venous insufficiency: a review.

Chronic venous insufficiency (CVI) is a very variable and complex entity that has stimulated different attempts at classification. Several proposals have been made in recent years, based on objective and anatomical criteria, most of them incomplete and unsatisfactory. Finally the CEAP classification was presented in 1994. This certainly is the most nearly complete classification, since it takes into consideration not only the main aspects of CVI: Clinical, Etiological, Anatomical, and Pathophysiological, but also the degrees of severity, reported in the form of scores. It is now accepted internationally although it still has some flaws (such as the absence of the corona phlebectactica sign) and inaccuracies (above all in the clinical part and the scoring). Recently, some members of the Promoting Committee proposed a substantial modification of the part on scores, coming closest to the clinical reality, instrumental diagnosis, and current therapies. The characteristics of CEAP enable us to affirm that this represents the most original and useful classification, not only for clinical studies, but also in the assessment of therapeutic results and in patient follow-up. Like all classifications, CEAP also needs to be validated by means of clinical studies in order to demonstrate its applicability. For this purpose, a European Working Group was set up in 1997. The first interesting results of 872 dossiers collected by means of a computerized program (European Phlebological File) were presented at several international congresses and concentrated on the consistency and reproducibility of the clinical part of the CEAP classification in different clinical settings.

The Epidemilogy of Chronic Venous Ulcer: Some Unanswered Questions

Objective: To highlight gaps in knowledge concerning the epidemiology of chronic venous insufficiency and to indicate what future studies are required. Methods: Existing classifications are compared. Limitations of epidemiological studies are defined. Data from published series and from the Edinburgh Vein Study are presented. Synthesis: The Basle 1978 classification of chronic venous insufficiency (CVI) is a purely clinical classification in which the earliest grade is corona phlebectatica. The Porter 1988 classification of CVI attempted to correlate clinical grades with sites of venous incompe-tence. However, a consistent relationship does not exist. The CEAP classification separates the clinical grades (which do not include corona phlebectasia) from the anatomical segments. The CEAP clinical classification covers a range of venous manifestations but is not consistent. There is a need for further consideration of classifications. Published selected series of patients show that the frequency of incompetence in both deep and superficial systems increases in proportion to the severity of the clinical manifestations of venous disease. To understand the significance of these data we need to know the patterns of venous incompetence in the general population. Data from 1566 subjects between the ages of 18 and 64 years in the Edinburgh Vein Study, a randomly selected cross-section of members of the Edinburgh population, showed that the prevalence of CVI was age-related and was present in 9.2% of men and 6.6% of women. Men had a significantly higher frequency of reflux in the deep system than women. In order to direct therapeutic interventions where they are most appropriate we need to know which patients with the early stages of varicose veins progress to CVI and which patients with early CVI progress to the serious skin complications. Conclusions: Key information concerning the natural history of venous disease and its evolution in relation to haemodynamic abnormalities awaits the findings of longitudinal-cohort epidemiological studies which include the duplex scanning of large populations.

Classification of chronic venous insufficiency.

Classification of chronic venous insufficiency.