Labropoulos N, Tiongson J, Pryor L, Tassiopoulos A K, Kang S S, Mansour M A, Baker W H
Department of Surgery, Loyola University Medical Center, Maywood, Illinois 60153-3304, USA.
J Vasc Surg. 2001 Nov;34(5):872-7. doi: 10.1067/mva.2001.118813.
Information on nonsaphenous superficial venous reflux is lacking. This study was designed to determine the prevalence of reflux in nonsaphenous veins, their association and correlation with risk factors, and signs and symptoms of chronic venous disease (CVD).
Information on 835 limbs in patients with signs and symptoms of CVD were prospectively entered into a customized database. These patients had been referred from the venous clinic to the vascular laboratory for color-flow duplex scanning evaluation of the lower-limb veins. All patients were examined for reflux in the standing and sitting positions. Nonsaphenous reflux was defined as that in superficial veins that are not part of the greater or lesser saphenous systems. Particular attention was paid to the patterns of reflux and anatomy of the nonsaphenous veins from the proximal to the distal ends, including their connections with the saphenous and deep veins.
Nonsaphenous venous reflux was found in 84 limbs (10%) of 72 patients, 67 of whom were women. The mean number of pregnancies in these patients was higher than that of 100 randomly selected women with saphenous reflux (3.2 vs 2.2). According to CEAP classification, 90% of the limbs were in CVD classes 1 through 3 and only 10% had skin damage (classes 4-6). Symptoms were present in 67 limbs (80%). Forty-two limbs (50%) had reflux in tributaries of lateral, posterior, and medial thigh. These veins were connected with perforators uniting with the deep femoral, femoral, and muscular veins of the thigh in 36 limbs. Reflux in these perforators was detected in 19 limbs. Reflux arising from the pelvic veins was found in 29 limbs (34%), 18 of which were from vulvar veins medial to saphenofemoral junction and 11 of which were from veins in the gluteal area. Incompetent veins from the sciatic nerve were found in nine limbs (10%). Reflux in the vein of the popliteal fossa was found in seven limbs (8%). Reflux in knee tributaries was detected in three limbs (4%), two of which were connected with posterolateral knee perforators and one with the posterior tibial nerve veins.
The prevalence of nonsaphenous reflux in our practice was 10%. The vast majority of these patients (93%) were women with a mean of 3.2 pregnancies. Ninety percent of these limbs have signs and symptoms assigned to CVD classes 1 to 3. These data may simply reflect the referral pattern, but also a possible association with female sex and number of pregnancies. The unusual anatomy of these veins stresses the importance of color-flow duplex scanning before surgery.
关于非隐静脉的浅静脉反流信息匮乏。本研究旨在确定非隐静脉反流的患病率、其与危险因素的关联及相关性，以及慢性静脉疾病（CVD）的体征和症状。
前瞻性地将835例有CVD体征和症状患者肢体的信息录入定制数据库。这些患者从静脉诊所转诊至血管实验室，接受下肢静脉彩色多普勒扫描评估。所有患者均在站立位和坐位进行反流检查。非隐静脉反流定义为不属于大隐静脉或小隐静脉系统的浅静脉反流。特别关注非隐静脉从近端到远端的反流模式和解剖结构，包括它们与隐静脉和深静脉的连接。
72例患者的84条肢体（10%）发现有非隐静脉反流，其中67例为女性。这些患者的平均妊娠次数高于随机选取的100例有隐静脉反流的女性（3.2次 vs 2.2次）。根据CEAP分类，90%的肢体属于CVD 1至3级，仅有10%有皮肤损伤（4至6级）。67条肢体（80%）有症状。42条肢体（50%）在大腿外侧、后侧和内侧的属支有反流。这些静脉在36条肢体中与连接股深静脉、股静脉和大腿肌肉静脉的穿通支相连。在19条肢体中检测到这些穿通支有反流。29条肢体（34%）发现有盆腔静脉反流，其中18条来自大隐静脉股静脉交界处内侧的外阴静脉，11条来自臀区静脉。9条肢体（10%）发现坐骨神经伴行静脉功能不全。7条肢体（8%）发现腘窝静脉反流。3条肢体（4%）检测到膝部属支反流，其中2条与膝后外侧穿通支相连，1条与胫后神经静脉相连。
在我们临床实践中,非隐静脉反流的患病率为10%。这些患者绝大多数（93%）为女性，平均妊娠3.2次。这些肢体中90%有CVD 1至3级的体征和症状。这些数据可能仅仅反映了转诊模式，但也可能与女性性别和妊娠次数有关。这些静脉的特殊解剖结构强调了手术前彩色多普勒扫描的重要性。
