Vein Size and Disease Severity in Chronic Venous Diseases

Abstract

Given the high prevalence of chronic venous diseases (CVD), defining criteria to screen patients who are in need for intervention is attaining primacy. An important clinical criterion for treating CVD is incompetence of larger veins. We have assessed the association of size of afflicted veins with disease severity in patients with CVD to define an acceptable criterion to identify patients who need intervention. Demographic characteristics and risk factors were recorded from 6350 patients. Based on physical examination and venous duplex ultrasound study, patients were classified into clinical severity, etiology, anatomy, and pathophysiology (CEAP) classes and grouped according to the size of the veins which had varicosities. Patients with reflux in smaller veins (vein size <4 mm diameter) were considered as type I and those with varicosities in truncal veins (>4 mm diameter) as type II. Risk ratio was determined by multivariate regression analysis. About 47.67% of patients in this study were found to have CEAP class 3 disease. Compared with varicose veins of large truncal veins, patients with varicosities in smaller superficial veins had 2.85-fold (p < 0.01) more risk of edema and 5.71-fold (p < 0.01) higher prevalence of hyperpigmentation. Varicosities in small superficial veins were associated with higher risk of ulceration (odds ratio 3.93, 95% confidence interval 2.51–6.18) compared with truncal vein reflux. Our study reveals that presence of small varicose veins in patients without truncal saphenous reflux involvement is associated with severe manifestations of venous insufficiency such as edema and skin lesions even in the absence of varicosities in truncal saphenous veins.

Keywords

chronic venous disease - varicose veins - CEAP classification - venous ulcers - great saphenous vein - small saphenous vein - vein reflux

Author Contributions

NR, CCK, and SS contributed to the conception and design of the study, acquisition of data, analysis, and drafting of the paper. SS and CCK analyzed, interpreted the results, and critically reviewed the manuscript, and DG and RJ contributed to the acquisition of data and drafting of the paper. All authors have read and approved the final manuscript.

• References

• 1 Meissner MH. Lower extremity venous anatomy. Semin Intervent Radiol 2005; 22 (03) 147-156
• 2 Vincent JR, Jones GT, Hill GB, van Rij AM. Failure of microvenous valves in small superficial veins is a key to the skin changes of venous insufficiency. J Vasc Surg 2011; 54 (6, Suppl): 62S-9S.e1–e3
• 3 Lane TRA, Varatharajan L, Fiorentino F. , et al. Truncal varicose vein diameter and patient-reported outcome measures. Br J Surg 2017; 104 (12) 1648-1655
• 4 Harris MR, Davies RJ, Brown S, Jones SM, Eyers PS, Chester JF. Surgical treatment of varicose veins: effect of rationing. Ann R Coll Surg Engl 2006; 88 (01) 37-39
• 5 Joh JH, Kim WS, Jung IM, Park KH, Lee T, Kang JM. ; Consensus Working Group. Consensus for the treatment of varicose vein with radiofrequency ablation. Vasc Spec Int 2014; 30 (04) 105-112
• 6 Eklöf B, Rutherford RB, Bergan JJ. , et al; American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 2004; 40 (06) 1248-1252
• 7 Seidel AC, Miranda Jr F, Juliano Y, Novo NF, dos Santos JH, de Souza DF. Prevalence of varicose veins and venous anatomy in patients without truncal saphenous reflux. Eur J Vasc Endovasc Surg 2004; 28 (04) 387-390
• 8 Khilnani NM, Min RJ. Imaging of venous insufficiency. Sem Interv Radiol 2005; 22: 178-184
• 9 Joh JH, Park HC. The cutoff value of saphenous vein diameter to predict reflux. J Korean Surg Soc 2013; 85 (04) 169-174
• 10 Lionis C, Erevnidou K, Antonakis N, Argyriadou S, Vlachonikolis I, Katsamouris A. ; CVI Research Group. Chronic venous insufficiency. A common health problem in general practice in Greece. Int Angiol 2002; 21 (01) 86-92
• 11 Carpentier PH, Maricq HR, Biro C, Ponçot-Makinen CO, Franco A. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France. J Vasc Surg 2004; 40 (04) 650-659
• 12 Perrin M, Ramelet AA. Pharmacological treatment of primary chronic venous disease: rationale, results and unanswered questions. Eur J Vasc Endovasc Surg 2011; 41 (01) 117-125
• 13 Mortimer PS, Pearson IC. Lymphatic function in severe chronic venous insufficiency. Phlebolymphology 2004; 44: 253-257
• 14 Nicholls SC. Sequelae of untreated venous insufficiency. Sem Interv Radiol 2005; 22: 162-168
• 15 Brown J. The role of the fibrin cuff in the development of venous leg ulcers. J Wound Care 2005; 14 (07) 324-327
• 16 Ahti TM, Mäkivaara LA, Luukkaala T, Hakama M, Laurikka JO. Effect of family history on the incidence of varicose veins: a population-based follow-up study in Finland. Angiology 2009; 60 (04) 487-491
• 17 Robertson L, Evans C, Fowkes FGR. Epidemiology of chronic venous insufficiency. Phlebology 2008; 11: 2-5
• 18 Aetna Insurance Inc. Varicose Veins; 2015 http://www.aetna.com/cpb/medical/data/1_99/0050.html . Accessed August 10, 2017
• 19 Subramonia S, Lees TA. The treatment of varicose veins. Ann R Coll Surg Engl 2007; 89 (02) 96-100
• 20 Carradice D, Wallace T, Gohil R, Chetter I. A comparison of the effectiveness of treating those with and without the complications of superficial venous insufficiency. Ann Surg 2014; 260 (02) 396-401
• 21 Radhakrishnan N, Jayakrishnan R, Deepu G. Microfoam sclerotherapy for varicose veins: a retrospective analysis of a modified technique. Indian J Surg 2015; 77 (Suppl 3): 816-821