Abstract:
Introduction: Occurrence of pathological venous reflux in the superficial veins of lower limbs is
considered to be the pathogenetic factor in the development of varicose veins. In the overwhelming
majority of cases venous reflux is diagnosed at the level of the saphenous system: either in the main
trunk (axial reflux) or in the tributaries assigned to the greater or lesser saphenous veins (non-axial
reflux). In contrast, non-saphenous venous reflux (NSVR) is deemed to be the pathological reflux in
superficial veins which are not attributable to the saphenous systems. Till date there is lack of
information on NSVR even in specialized medical literature, this kind of venous hemodynamic
disorders being often underdiagnosed in daily clinical practice. This study was designed to determine
the prevalence and distribution of NSVR in patients with varicose veins depending on age, gender and C
class of Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification.
Materials and Methods: Information on 463 patients (546 limbs) consulted with varicose
veins during a two years period was analyzed in a retrospective study. Anthropometric data were
recorded, while involved limbs were distributed according to CEAP classification. Affected
extremities were examined with duplex ultrasound scanning and conventionally split up into two
groups based on the source of venous reflux - group I (saphenous reflux) and group II (NSVR).
Clinical and imaging data were subsequently assessed.
Results: NSVR was diagnosed in 42 (7.69%) limbs of 38 patients. We identified the sources
of NSVR as following: perforator veins of lateral, posterior and medial thigh (n=9, 21.4%); pelvic
veins (n=17, 40.47% ) including vulvar veins and veins from the gluteal area; branch from common
femoral vein (n=3, 7.14%); veins of popliteal fossa (n=12, 28.57%); knee tributaries (n=l, 2.38%).
There was noted more frequent detection of NSVR in female patients - 31/38 (81.57%), with a
female/male ratio of 4.42/1 in group II versus 1.85/1 - in group I. The average age of patients from
group I was 52.78 years (ranging from 18 to 90 yrs) versus 37.43 years (ranging from 18 till 48 yrs)
- registered in pts from second group. The C2-3 (CEAP)/C4-6 (CEAP) ratio was 1.69/1 - in group I
versus 7.4/1 - in the group II.
Conclusion: Patients with varicose veins present various patterns of venous reflux. NSVR
had a prevalence of 7.69% in our study, being revealed most common in young female patients,
with low till moderate clinical severity (class C2-3 according to CEAP classification) of chronic
venous disease. Meticulous duplex ultrasound examination of patients with varicose veins is crucial
in order to establish the precise origin of the pathological venous reflux
Description:
Department of
General Surgery and Semiology, State Medical and Pharmaceutical University “Nicolae Testemitanu”,
Chisinau, Republic of Moldova