open access

Vol 26, No 3 (2020)
Research paper
Published online: 2021-01-17
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Clinical symptoms and signs and severity of venous disease are not associated with non-thrombotic iliac vein lesions in patients with primary varicose veins

Radosław Krzyżański, Łukasz Kruszyna, Łukasz Dzieciuchowicz
DOI: 10.5603/AA.2020.0019
·
Acta Angiologica 2020;26(3):90-95.

open access

Vol 26, No 3 (2020)
Original papers
Published online: 2021-01-17

Abstract

Introduction and purpose. The purpose of this study was to determine relationship between non-thrombotic iliac vein lesions and symptomatology of primary varicose veins (PVV). The identification of such association would be helpful in selecting patients with PVV for further diagnostic evaluation. Material and methods. Thirty-two patients with unilateral PVV scheduled for great saphenous vein high ligation and stripping were enrolled in the study. There were 25 (78%) women. The mean age of the patients was 48 years. The patients were asked about pain, oedema, night cramps, heaviness and a history of superficial thrombophlebitis in PVV limb. A clinical stage of CEAP classification was determined and Venous Clinical Severity Score (VCSS) was calculated. During the surgery right and left iliac venous axes were interrogated with an intravascular ultrasound with Volcano s5 Imaging System (Volcano Corporation, Rancho Cordova, CA, USA) and catheters Visions PV .035 minimal lumen area (MLA) and percentage of stenosis (%S) of examined veins were calculated. An association between clinical symptoms and signs in PVV limb and %S of ipsilateral common iliac vein (CIV) and external iliac vein (EIV) was statistically analysed. Results. Pain, oedema, night cramps, heaviness and history of superficial thrombophlebitis were reported by 14 (44%), 17 (53%), 11 (34%), 19 (59%) and 6 (19%) of patients respectively. Twenty-five (78%) limbs were classified as C2 and 7 (22%) limbs as C4a according to CEAP classification. The median VCSS was 4. The mean MLA and %S was 92,9 mm2 and 47% and 74,2 mm2 and 48% for CIV and EIV respectively. Neither smaller MLA nor greater %S of CIV and EIV were associated with symptoms, more advanced stage of CEAP classification or higher VCSS. Conclusions. Neither clinical symptoms nor severity of venous disease can identify non-thrombotic iliac vein lesions in patients with primary varicose veins.

Abstract

Introduction and purpose. The purpose of this study was to determine relationship between non-thrombotic iliac vein lesions and symptomatology of primary varicose veins (PVV). The identification of such association would be helpful in selecting patients with PVV for further diagnostic evaluation. Material and methods. Thirty-two patients with unilateral PVV scheduled for great saphenous vein high ligation and stripping were enrolled in the study. There were 25 (78%) women. The mean age of the patients was 48 years. The patients were asked about pain, oedema, night cramps, heaviness and a history of superficial thrombophlebitis in PVV limb. A clinical stage of CEAP classification was determined and Venous Clinical Severity Score (VCSS) was calculated. During the surgery right and left iliac venous axes were interrogated with an intravascular ultrasound with Volcano s5 Imaging System (Volcano Corporation, Rancho Cordova, CA, USA) and catheters Visions PV .035 minimal lumen area (MLA) and percentage of stenosis (%S) of examined veins were calculated. An association between clinical symptoms and signs in PVV limb and %S of ipsilateral common iliac vein (CIV) and external iliac vein (EIV) was statistically analysed. Results. Pain, oedema, night cramps, heaviness and history of superficial thrombophlebitis were reported by 14 (44%), 17 (53%), 11 (34%), 19 (59%) and 6 (19%) of patients respectively. Twenty-five (78%) limbs were classified as C2 and 7 (22%) limbs as C4a according to CEAP classification. The median VCSS was 4. The mean MLA and %S was 92,9 mm2 and 47% and 74,2 mm2 and 48% for CIV and EIV respectively. Neither smaller MLA nor greater %S of CIV and EIV were associated with symptoms, more advanced stage of CEAP classification or higher VCSS. Conclusions. Neither clinical symptoms nor severity of venous disease can identify non-thrombotic iliac vein lesions in patients with primary varicose veins.

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Keywords

non-thrombotic iliac vein lesions, primary varicose veins, clinical symptoms and signs

About this article
Title

Clinical symptoms and signs and severity of venous disease are not associated with non-thrombotic iliac vein lesions in patients with primary varicose veins

Journal

Acta Angiologica

Issue

Vol 26, No 3 (2020)

Article type

Research paper

Pages

90-95

Published online

2021-01-17

DOI

10.5603/AA.2020.0019

Bibliographic record

Acta Angiologica 2020;26(3):90-95.

Keywords

non-thrombotic iliac vein lesions
primary varicose veins
clinical symptoms and signs

Authors

Radosław Krzyżański
Łukasz Kruszyna
Łukasz Dzieciuchowicz

References (20)
  1. May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology. 1957; 8(5): 419–427.
  2. Cockett FB, Thomas ML. The iliac compression syndrome. Br J Surg. 1965; 52(10): 816–821.
  3. Kibbe MR, Ujiki M, Goodwin AL, et al. Iliac vein compression in an asymptomatic patient population. J Vasc Surg. 2004; 39(5): 937–943.
  4. Neglén P, Raju S. Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg. 2002; 35(4): 694–700.
  5. Eklöf Bo, Rutherford R, Bergan J, et al. Revision of the CEAP classification for chronic venous disorders: Consensus statement. Journal of Vascular Surgery. 2004; 40(6): 1248–1252.
  6. Rutherford RB, Padberg FT, Comerota AJ, et al. Venous severity scoring: An adjunct to venous outcome assessment. J Vasc Surg. 2000; 31(6): 1307–1312.
  7. Hach W. [Diagnosis and surgical methods in primary varicose veins]. Langenbecks Arch Chir. 1988; Suppl 2: 145–151.
  8. Dzieciuchowicz Ł, Krzyżański R, Kruszyna Ł, et al. Prevalence of Non-thrombotic Iliac Vein Lesions in Patients with Unilateral Primary Varicose Veins. Eur J Vasc Endovasc Surg. 2016; 51(3): 429–433.
  9. Hingorani A, Alhabouni S, Ascher E, et al. Role of IVUS Versus Venograms in Assessment of Iliac-Femoral Vein Stenosis. Journal of Vascular Surgery. 2010; 52(3): 804.
  10. Montminy ML, Thomasson JD, Tanaka GJ, et al. A comparison between intravascular ultrasound and venography in identifying key parameters essential for iliac vein stenting. J Vasc Surg Venous Lymphat Disord. 2019; 7(6): 801–807.
  11. Gagne PJ, Tahara RW, Fastabend CP, et al. Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction. J Vasc Surg Venous Lymphat Disord. 2017; 5(5): 678–687.
  12. Neglén P, Hollis KC, Olivier J, et al. Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg. 2007; 46(5): 979–990.
  13. Shiferson A, Aboian E, Shih M, et al. Iliac venous stenting for outflow obstruction does not significantly change the quality of life of patients with severe chronic venous insufficiency. JRSM Cardiovasc Dis. 2019; 8(3): 2048004019890968.
  14. Gagne PJ, Gasparis A, Black S, et al. Analysis of threshold stenosis by multiplanar venogram and intravascular ultrasound examination for predicting clinical improvement after iliofemoral vein stenting in the VIDIO trial. J Vasc Surg Venous Lymphat Disord. 2018; 6(1): 48–56.e1.
  15. Seager MJ, Busuttil A, Dharmarajah B, et al. Editor's Choice-- A Systematic Review of Endovenous Stenting in Chronic Venous Disease Secondary to Iliac Vein Obstruction. Eur J Vasc Endovasc Surg. 2016; 51(1): 100–120.
  16. Gagne PJ, Gagne N, Kucher T, et al. Long-term clinical outcomes and technical factors with the Wallstent for treatment of chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord. 2019; 7(1): 45–55.
  17. Elsharawy MA, Naim MM, Abdelmaguid EM, et al. Role of saphenous vein wall in the pathogenesis of primary varicose veins. Interact Cardiovasc Thorac Surg. 2007; 6(2): 219–224.
  18. Lim CS, Davies AH. Pathogenesis of primary varicose veins. Br J Surg. 2009; 96(11): 1231–1242.
  19. Kakkos SK, Nicolaides AN. Efficacy of micronized purified flavonoid fraction (Daflon®) on improving individual symptoms, signs and quality of life in patients with chronic venous disease: a systematic review and meta-analysis of randomized double-blind placebo-controlled trials. Int Angiol. 2018; 37(2): 143–154.
  20. Masuda E, Ozsvath K, Vossler J, et al. The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology. J Vasc Surg Venous Lymphat Disord. 2020; 8(4): 505–525.e4.

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