Clinic and demographic characteristics of the patients with varicose veins and type 1 reflux according to pittaluga classification

Abstract

Introduction. Treatment of varicose veins of the lower limbs has undergone significant changes in the last decades. The classification of hemodynamic disorders, proposed by P.Pittaluga (2008), not only reflects the most common types of reflux in varicose veins (VV), but also suggests the optimal curative approach. Type 1 of venous reflux, defined as the presence of varicose tributaries on the thigh / leg with competent saphenous-femoral junction and saphenous trunk, is a less studied form of varicose disease. Aim of the study. Evaluation of clinical-demographic characteristics of patients with varicose disease and type 1 of venous reflux according to P.Pittaluga classification. Materials and methods. In the retrospective analysis were included 98 patients (122 extremities with VV in the great saphenous vein system), supposed to clinical, examination, ultrasound imaging and saphenous sparing surgery. Results. From totality of limbs supposed to saphenous sparing surgery, type 1 reflux was diagnosed in 27 (22, 1%) cases. Other types were: type 3 - 18 (14.7%), type 4 - 47 (38.5%), type 5 - 30 (24.5%) cases. The median age in patients with reflux type 1 was - 44 years (IQR 29-62) vs. 44.6 years (IQR 33.5-55.5) in patients with types 3-5. The distribution of patients by sex did not differ significantly. The mean duration of VV constituted 6.7±4.3 years in case of reflux type 1 vs. 11.73±8.53 years in case of reflux types 3-5. Distribution according to the clinical criteria of CEAP classification in patients with type 1 reflux was: C2A - 11 (40.7%), C2S - 11 (40.7%) and C3 - 5 (18.5%) cases. In patients with reflux types 3-5: C2A - 17 (17.9%), C2S - 45 (47.3%), C3 - 28 (29.4%), C4-6 - 5 (5.2%). The mean value of BMI in patients with type 1 was 24.5±4.8 vs 25.6 ± 5.7 in types 3-5. Conclusions. About one fifth of patients with VV, supposed to saphenous sparing surgery had isolated reflux in the tributaries of great saphenous vein. Type 1 reflux is characteristic for early stage of VV and is associated with double rate of asymptomatic cases compared to other types of the reflux. Obtained data support the ascending theory of progression of venous reflux and opportunity of saphenous sparing strategies in the management of VV.