Navarro Tulio P, Delis Konstantinos T, Ribeiro Antonio P
Vascular Laboratory, Federal University Hospital, Minas Gerais, Belo Horizonte, Brazil.
Arch Surg. 2002 Nov;137(11):1233-7. doi: 10.1001/archsurg.137.11.1233.
As the compliant greater saphenous vein (GSV) adjusts its luminal size to the level of transmural pressure, measurement of its diameter, reflecting the severity of hemodynamic compromise in limbs with GSV reflux, may simplify the hemodynamic criteria of patient selection for saphenectomy.
To evaluate the clinical significance of GSV diameter determined in the thigh and calf as a marker of global hemodynamic impairment and clinical severity in a model comprising patients with saphenofemoral junction and truncal GSV incompetence.
A cohort study.
University-associated tertiary care hospitals in Brazil and England.
Eighty-five consecutive patients, aged 28 to 82 (mean, 46.2) years; 112 lower limbs with saphenofemoral junction and truncal GSV incompetence were investigated.
Clinical examination was followed by clinical, etiological, anatomical, and pathophysiological classification (CEAP), vein duplex, and air plethysmography. The GSV diameter was measured on standing at the knee, and at 10, 20, and 30 cm above and below the knee, and in the thigh and calf, respectively, using B-mode imaging. The venous filling index (VFI), venous volume (VV), and residual volume fraction (RVF) were measured by air plethysmography.
The GSV diameter was correlated with the VFI, VV, RVF, and CEAP. The value of the GSV diameter for predicting the presence of critical reflux (VFI >7 mL/s) or the absence of abnormal reflux (VFI <2 mL/s) was determined with receiver-operator curves.
The GSV diameter increased significantly overall with CEAP (P<.001) and also increased progressively with proximity to the saphenofemoral junction. The VFI, VV, and RVF increased significantly from CEAP(0) through CEAP(4-6); the VFI correlated well with VV, RVF, and CEAP (P<.001 for all). The GSV diameter at all 7 limb levels studied correlated well with VV (except at the distal calf), VFI, RVF, and CEAP (P< or =.009 for all). A GSV diameter of 5.5 mm or less predicted the absence of abnormal reflux, with a sensitivity of 78%, a specificity of 87%, positive and negative predictive values of 78%, and an accuracy of 82%. A GSV diameter of 7.3 mm or greater predicted critical reflux (VFI >7 mL/s), with an 80% sensitivity, an 85% specificity, and an 84% accuracy.
The GSV diameter proved to be a relatively accurate measure of hemodynamic impairment and clinical severity in a model of saphenofemoral junction and GSV incompetence, predicting not only the absence of abnormal reflux, but also the presence of critical venous incompetence, assisting in clinical decision making before considering greater saphenectomy.
由于顺应性大隐静脉（GSV）会将其管腔大小调整至跨壁压力水平，测量其直径可反映大隐静脉反流肢体中血流动力学受损的严重程度，这可能会简化大隐静脉切除术患者选择的血流动力学标准。
在一个包含股隐静脉交界处和主干大隐静脉功能不全患者的模型中，评估在大腿和小腿测量的大隐静脉直径作为整体血流动力学损害和临床严重程度标志物的临床意义。
队列研究。
巴西和英国与大学相关的三级护理医院。
85例连续患者，年龄28至82岁（平均46.2岁）；对112条存在股隐静脉交界处和主干大隐静脉功能不全的下肢进行了研究。
临床检查后进行临床、病因、解剖和病理生理分类（CEAP）、静脉双功超声检查和空气容积描记法。使用B型成像分别在站立位时的膝关节处、膝关节上下10、20和30 cm处以及大腿和小腿测量大隐静脉直径。通过空气容积描记法测量静脉充盈指数（VFI）、静脉容量（VV）和残余容量分数（RVF）。
大隐静脉直径与VFI、VV、RVF和CEAP相关。用受试者工作特征曲线确定大隐静脉直径预测严重反流（VFI>7 mL/s）或无异常反流（VFI<2 mL/s）的价值。
大隐静脉直径总体上随CEAP显著增加（P<.001），并且随着靠近股隐静脉交界处而逐渐增加。VFI、VV和RVF从CEAP（0）到CEAP（4 - 6）显著增加；VFI与VV、RVF和CEAP相关性良好（所有P<.001）。在研究的所有7个肢体水平上，大隐静脉直径与VV（小腿远端除外）、VFI、RVF和CEAP相关性良好（所有P≤.009）。大隐静脉直径≤5.5 mm预测无异常反流，敏感性为78%，特异性为87%，阳性和阴性预测值为78%，准确性为82%。大隐静脉直径≥7.3 mm预测严重反流（VFI>7 mL/s），敏感性为80%，特异性为85%，准确性为84%。
在股隐静脉交界处和大隐静脉功能不全的模型中，大隐静脉直径被证明是血流动力学损害和临床严重程度的相对准确指标，不仅能预测无异常反流，还能预测严重静脉功能不全的存在，有助于在考虑做大隐静脉切除术之前进行临床决策。
