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INTERNATIONAL ANGIOLOGY

A Journal on Angiology


Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2018 Jan 26

DOI: 10.23736/S0392-9590.18.03901-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Investigation of non-saphenous veins in C0S patients

Marzia LUGLI 1 , Oscar MALETI 1, M Letizia IABICHELLA 1, Michel PERRIN 2

1 Department of Cardiovascular Surgery, Hesperia Hospital, Modena, Italy; 2 Jean Kunlin Vascular Pathology Unit, Lyon, France


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BACKGROUND: C0S patients have symptoms of chronic venous disorder (CVD), though an anatomical or pathophysiological explanation is lacking. C0 and C1 classified lower limbs can present with valve incompetence from the second to sixth generation of tributaries of saphenous veins despite the absence of a detectable saphenous truncal reflux. We hypothesized that C0S venous symptoms could stem from the second to sixth generation of saphenous tributaries and small veins that are not connected to the saphenous system. The aim was to explore these veins in C0S subjects and compare them with asymptomatic C0A subjects.
METHODS: This was an open, controlled study enrolling 36 subjects, where C0s patients (n=18) were compared with asymptomatic C0A subjects (n=18). The VAS (visual analog scale) was used to assess leg pain. Veins were assessed using B-Flow ultrasound (valve anatomy), continuous wave (CW) Doppler (flow patterns), biomicroscopy (visualization of nutritional vessels), Laser Doppler Flowmetry (quantify supine microvascular perfusion) and quantitative digital photoplethysmography (PPG) (measuring post-exercise venous refilling time [VRT]).
RESULTS: There were no significant differences between C0S and C0A subjects in terms of microvascular perfusion (laser-Doppler), nutritional vessels (biomicroscopy) and VRT (PPG). Bflow ultrasound was unable to acquire sufficient data in second generation saphenous tributaries. However, the CW Doppler identified two different flow patterns: uni- and bidirectional. Bidirectional flow was significantly (P=.05) higher in C0S versus C0A patients.
CONCLUSIONS: CW Doppler, using a flat high-sensitivity probe, revealed the presence of a bidirectional flow that was significantly (P=.05) higher in C0S than in control patients, suggesting the presence of reflux in axial veins. These data give a new perspective on the management of C0S patients.


KEY WORDS: Microvalves - Venous symptoms - Chronic venous disorder - Non-saphenous reflux

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Publication History

Article first published online: January 26, 2018
Manuscript accepted: January 23, 2018
Manuscript received: August 3, 2017

Cite this article as

Lugli M, Maleti O, Iabichella ML, Perrin M. Investigation of non-saphenous veins in C0S patients. Int Angiol 2018 Jan 26. DOI: 10.23736/S0392-9590.18.03901-9

Corresponding author e-mail

lugli@chirurgiavascolaremodena.it