Correlation between GSV diameter and varicose clinics

Summary

Background Great saphenous vein (GSV) incompetence is involved in the majority of cases of varicose disease. Stratification of venous disease severity is still difficult. This study aims to correlate GSV diameters with C of CEAP and the venous clinical severity score (VCSS).

Methods Legs without GSV reflux (Control legs, Group 1) and legs with untreated isolated GSV reflux and varicose veins limited to the GSV territory (Group 2) were studied clinically and with duplex ultrasound in a prospective study. The GSV diameters were measured both next to the saphenofemoral junction (SFJ) and at proximal thigh (PT) and correlated to the C of CEAP and VCSS.

Results The control legs-group 1 were: n=33, 6 male, mean age 53, mean BMI 26.

The legs with reflux-group 2 were: n=78, 16 male, mean age 54, mean BMI 27.

The mean diameters for the SFJ ( ± SD) for groups 1 and 2 were 6.4 ± 1.8 and 9.9 ± 3.4. For PT they were 3.6 ± 0.9 and 5.9 ± 1.8 respectively. In legs with reflux the SFJ diameter correlates strongly with the PT diameter (r=0.69) and moderately with the C of CEAP and VCSS; 0.42 and 0.45 respectively. The PT diameter correlates slightly better with the C of CEAP and VCSS than the SFJ diameter (0.55 and 0.57). The mean values of VCSS for groups 1 and 2 were 0.70. and 4.69. The C of CEAP and VCSS show a strong correlation among them with r=0.79 in group 2 and 0.80 in the whole sample.

Conclusion The GSV diameters next to the SFJ and particularly at the PT in patients having reflux correlate strongly with both the C of CEAP and VCSS. Recording the GSV diameters at the SFJ and PT in a standardized way may improve comparison of published data and contribute to choice of treatment in the future.

Keywords

GSV - SFJ - Proximal thigh - vein diameter - VCSS - CEAP

• References

• 1 Maurins U, Hoffmann BH, Losch C, Jockel KH, Rabe E, Pannier F. Distribution und prevalence of reflux in the superficial und deep venous system in the general population--results from the Bonn Vein Study, Germany. J Vasc Surg 2008; 48 (03) 680-687.
• 2 Cappelli M, Molino RLova, Ermini S, Zamboni P. Hemodynamics of the sapheno-femoral junction. Patterns of reflux und their clinical implications. Int Angiol 2004; 23 (01) 25-28.
• 3 Mendoza E, Blattler W, Amsler F. Great saphenous vein diameter at the saphenofemoral junction und proximal thigh as parameters of venous disease class. Eur J Vasc Endovasc Surg 2013; 45 (01) 76-83.
• 4 Morbio AP, Sobreira ML, Rollo HA. Correlation between the intensity of venous reflux in the saphenofemoral junction und morphological changes of the great saphenous vein by duplex scanning in patients with primary varicosis. Int Angiol 2010; 29 (04) 323-330.
• 5 Philipsen TE, De Maeseneer MG, Vandenbroeck CP, Van Schil PE. Anatomical patterns of the above knee great saphenous vein und its tributaries: implications for endovenous treatment strategy. Acta Chir Belg 2009; 109 (02) 176-179.
• 6 De Maeseneer MG, Biemans AA. Re. ‘Great saphenous vein diameter at the saphenofemoral junction und proximal thigh as parameters of venous disease class. Eur J Vasc Endovasc Surg 2013; 46 (01) 151 (letter).
• 7 De Maeseneer M, Pichot O, Cavezzi A, Earnshaw J, van Rij A, Lurie F, Smith PC. Duplex ultrasound investigation of the veins of the lower limbs after treatment for varicose veins – UIP consensus document. Eur J Vasc Endovasc Surg 2011; 42 (01) 89-102.
• 8 Gibson K, Meissner M, Wright D. Great saphenous vein diameter does not correlate with worsening quality of life scores in patients with great saphenous vein incompetence. J Vasc Surg 2012; 56 (06) 1634-1641.
• 9 Mendoza E. Provocation manoeuvres for the duplex ultrasound diagnosis of varicose veins. Phlebologie 2013; 42 (06) 357-362. (English version).
• 10 Labropoulos N, Tiongson J, Pryor L, Tassiopoulos AK, Kang SS, Ashraf MMansour, Baker WH. Definition of venous reflux in lower-extremity veins. J Vasc Surg 2003; 38 (04) 793-798.
• 11 Vasquez MA, Munschauer CE. Venous Clinical Severity Score und quality-of-life assessment tools: application to vein practice. Phlebology 2008; 23 (06) 259-275.
• 12 Eklof B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, Meissner MH, Moneta GL, Myers K, Padberg FT, Perrin M, Ruckley CV, Smith PC, Wakefield TW. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 2004; 40 (06) 1248-1252.
• 13 Navarro TP, Delis KT, Ribeiro AP. Clinical und hemodynamic significance of the greater saphenous vein diameter in chronic venous insufficiency. Arch Surg 2002; 137 (11) 1233-1237.
• 14 Pichot O, De Maeseneer M. Treatment of varicose veins: does each technique have a formal indication?. Perspect Vasc Surg Endovasc Ther 2011; 23 (04) 250-254.
• 15 Mdez-Herrero A, Gutierrez J, Camblor L, Carreno J, Llaneza J, Rguez-Olay J, Suarez E. The relation among the diameter of the great saphenous vein, clinical state und haemodynamic pattern of the saphenofemoral junction in chronic superficial venous insufficiency. Phlebology 2007; 22 (05) 207-213.
• 16 Nicolaides AN, Kakkos S, Eklof B, Perrin M, Nelzen O, Neglen P, Partsch H, Rybak Z, Kalodiki E. Management of chronic venous disorders of the lower limbs. Guidelines according to scientific evidence. IUA consensus statement. Int Angiol 2014; 33 (02) 87-208.