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
