Labropoulos N, Giannoukas A D, Delis K, Kang S S, Mansour M A, Buckman J, Katsamouris A, Nicolaides A N, Littooy F N, Baker W H
Division of Vascular Surgery, Loyola University Medical Center, Maywood, IL 60153-3304, USA.
J Vasc Surg. 2000 Nov;32(5):954-60. doi: 10.1067/mva.2000.110349.
The purpose of this study was to determine the patterns of isolated lesser saphenous vein (LSV) system incompetence and correlate the distribution and extent of such reflux with symptoms and signs of chronic venous disease (CVD).
During a 3-year period, 2254 limbs in 1682 patients with signs and symptoms of CVD were evaluated with color flow duplex scanning. Extremities with isolated reflux in the LSV system were selected for this study. Limbs with perforating venous reflux connected to this system only were also included. Limbs that had marked reflux in the greater saphenous or deep vein, that had a documented history of deep venous thrombosis, and that previously underwent surgery or sclerotherapy were excluded. The clinical severity of the limbs was graded with the CEAP classification system.
There were 226 limbs in 200 patients with reflux in the LSV system; 61% were female patients with a mean age of 49 years (range, 18-82 years). There were 174 patients (87%) with unilateral and 26 with bilateral disease, and 41% of the limbs belonged in CVD class 2, 26% in class 3, 12% in class 4, 3.5% in class 5, and 3% in class 6. Classes 0 and 1 were present in 14.5% of the limbs. Symptoms were present in 139 limbs (61.5%). Some degree of ache or burning sensation was the most frequent symptom (41%), followed by itching (32%), heaviness (29%), cramps (24%), and restless limbs (18%). Reflux in the main trunk of the LSV was the most prevalent (177 limbs [78%]), followed by the saphenopopliteal junction (146 limbs [64.6%]), the vein of Giacomini (39 limbs [17%]) and the gastrocnemial vein (23 limbs [10%]). Reflux involving both the saphenopopliteal junction and the LSV was seen in 50% of limbs, but almost any other combination of reflux was present, which indicated the complexity of this system. Perforator vein incompetence was detected in 56 limbs (25%). We found 83 perforator veins, resulting in a mean of 1.5 veins per limb. Both the number of incompetent perforator veins and the extent of superficial reflux correlated with clinical severity. Four main types of termination of the LSV were identified with at least nine variations. The LSV was duplicated for at least half of its length in five limbs (2.2%). Nonsaphenous reflux was detected in seven limbs (3.1%). Superficial vein thrombosis in the LSV system was found in eight limbs (3.5%), and in the gastrocnemial vein it was found in four (1.8%).
Isolated LSV system incompetence can cause the entire range of signs and symptoms of CVD. Clinical deterioration is associated with a longer extent of reflux and perforator incompetence. Classes 2 to 4 are the most frequent clinical presentations, whereas classes 5 and 6 are uncommon. The complex anatomy of this system and the great variation in the patterns of reflux warrant the use of color flow duplex scanning before planning treatment.
本研究的目的是确定单纯小隐静脉（LSV）系统功能不全的模式，并将这种反流的分布和程度与慢性静脉疾病（CVD）的症状和体征相关联。
在3年期间，对1682例有CVD症状和体征的患者的2254条肢体进行了彩色血流双功扫描评估。本研究选择了LSV系统存在单纯反流的肢体。仅与该系统相连的穿支静脉反流的肢体也包括在内。大隐静脉或深静脉有明显反流、有深静脉血栓形成记录史以及先前接受过手术或硬化治疗的肢体被排除。采用CEAP分类系统对肢体的临床严重程度进行分级。
200例患者的226条肢体存在LSV系统反流；61%为女性患者，平均年龄49岁（范围18 - 82岁）。174例患者（87%）为单侧病变，26例为双侧病变，41%的肢体属于CVD 2级，26%属于3级，12%属于4级，3.5%属于5级，3%属于6级。0级和1级在14.5%的肢体中存在。139条肢体（61.5%）有症状。某种程度的疼痛或烧灼感是最常见的症状（41%），其次是瘙痒（32%）、沉重感（29%）、痉挛（24%）和肢体不安（18%）。LSV主干反流最为常见（177条肢体[78%]），其次是隐腘静脉交界处（146条肢体[64.6%]）、 Giacomini静脉（39条肢体[17%]）和腓肠静脉（23条肢体[10%]）。50%的肢体可见隐腘静脉交界处和LSV均有反流，但几乎存在任何其他反流组合，这表明该系统的复杂性。56条肢体（25%）检测到穿支静脉功能不全。共发现83条穿支静脉，平均每条肢体1.5条。功能不全的穿支静脉数量和浅静脉反流程度均与临床严重程度相关。确定了LSV的四种主要终止类型，至少有九种变异。5条肢体（2.2%）的LSV至少一半长度为双支。7条肢体（3.1%）检测到非隐静脉反流。LSV系统浅静脉血栓形成在8条肢体（3.5%）中发现，腓肠静脉中在4条肢体（- 1.8%）中发现。
单纯LSV系统功能不全可导致CVD的全部体征和症状。临床恶化与反流时间延长和穿支功能不全有关。2至4级是最常见的临床表现，而5级和6级不常见。该系统复杂的解剖结构和反流模式的巨大差异使得在制定治疗方案前使用彩色血流双功扫描很有必要。
