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International Angiology 2002 June;21(2):187-92


language: English

Clinical presentation and anatomic distribution of chronic venous insufficiency of the lower limb in a typical Mediterranean population

Giannoukas A. D., Tsetis D., Ioannou C., Kostas T., Kafetzakis A., Petinarakis I., Kardoulas D., Touloupakis E., Katsamouris A.

Division of Vascular Surgery and *Department of Radiology, University Hospital of Heraklion University of Crete School of Medicine, Heraklion, Crete, Greece


Background. The aim of this study was to dem­on­strate the char­ac­ter­is­tics of lower limb chron­ic ­venous insuf­fi­cien­cy (CVI) in a homog­e­nous Mediterranean pop­u­la­tion.
Methods. Investigation of 694 ­patients with uni- or bilat­er­al symp­toms and signs of lower limb CVI using ­colour ­duplex scan­ning. Limbs with pre­vi­ous ­venous sur­gery were exclud­ed. The limbs were clas­si­fied accord­ing to his­to­ry and ultra­son­ic find­ings into those with post-throm­bot­ic and those with pri­mary CVI. The clin­i­cal pres­en­ta­tion accord­ing to the CEAP clas­sifi­ca­tion was cor­re­lat­ed to the ana­tom­ic dis­tri­bu­tion of ­venous ­reflux.
Results. Most of the symp­to­mat­ic limbs (537/656, 81.5%) with pri­mary CVI ­belonged to class­es 1 to 3. In these limbs ­reflux con­fined to super­fi­cial veins was very com­mon (64.5%, 424/656) where­as the prev­a­lence of deep and per­fo­ra­tor vein ­reflux was 18.5 and 25.5%, respec­tive­ly. In con­trast most of the limbs (69.5%) with post-throm­bot­ic CVI ­belonged to class­es 4 to 6, had a com­plex pat­tern of ­reflux, and involve­ment of deep and per­fo­ra­tor veins was com­mon (86.5 and 48%, respec­tive­ly). In about a quar­ter (24%) of ­patients with sus­pect­ed pri­mary CVI no ­reflux was found in ­either limb on ­duplex scan­ning. Most of them (48%) had telan­giec­ta­sis. Bilateral ­reflux was found in 71% of the ­patients with pri­mary CVI.
Conclusions. The clin­i­cal pres­en­ta­tion was worse in limbs with post-throm­bot­ic CVI than in those with a pri­mary dis­ease. Post-throm­bot­ic CVI was asso­ciat­ed with a com­plex pat­tern of ­reflux, affect­ing most­ly the deep and per­fo­ra­tor veins, where­as super­fi­cial ­reflux was the most com­mon pat­tern in limbs with pri­mary CVI. Therefore, sur­gery aim­ing to elim­i­nate super­fi­cial ­reflux would con­fer only a min­i­mal ben­e­fit in limbs with post-throm­bot­ic CVI but would treat the major­ity of the limbs with the pri­mary CVI. The high prev­a­lence of bilat­er­al ­reflux found in ­patients with pri­mary CVI sug­gests a bilat­er­al pre­dis­po­si­tion, which sup­ports the hypoth­e­sis of the exis­tence of a gen­er­al­ised ­venous dis­ease.

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