Ibegbuna V, Delis K T, Nicolaides A N
Faculty of Medicine, Imperial College, St Mary's Hospital, Paddington, London.
Eur J Vasc Endovasc Surg. 2006 May;31(5):535-41. doi: 10.1016/j.ejvs.2005.10.024. Epub 2006 Jan 4.
The purpose of this study was to assess the effect of venous incompetence of the deep, superficial and perforator veins combined (i.e. multi-system incompetence) on the venous haemodynamics and clinical condition of limbs with chronic venous disease (CVD).
One hundred and thirty two limbs (16-C(1); 30-C(2); 20-C(3); 25-C(4); 21-C(5); 20-C(6)) of 121 patients were studied. We excluded those with previous venous surgery/sclerotherapy, peripheral arterial disease, recent deep vein thrombosis (< or =6 months), or inability to comply with the tests. The CEAP clinical class was assessed. Duplex ultrasonography (ultrasound) enabled classification according to: the presence of superficial([S]) (+/- perforator([P])) or deep([D]) (+/-S, +/-P) reflux (>.5s); the number of incompetent venous systems (single-system([S/P/D]), dual-system([S+P/S+D/P+D]), or triple-system([S+P+D])), and the number of incompetent perforators([0/1/2/> or =3]). The amount of reflux (Venous Filling Index([VFI])); calf pump Ejection Fraction([EF]), and Residual Volume Fraction([RVF]) were studied with air-plethysmography.
VFI in limbs with triple-system incompetence (VFI median 6.68 [IQR: 4.7-9.7]ml/s) was higher than in limbs with dual-system incompetence (4.5 [2.1-7.4]ml/s), and VFI in the latter was higher than in limbs with single-system incompetence (1.3 [0.69-2.3]ml/s)(p<0.01 Kruskal-Wallis). Although EF changes were small, RVF in limbs with triple-incompetence (39 [30-51] %) was higher than in single-system incompetence (26 [16-33] %)(p<0.01 Mann-Whitney). Limbs with superficial (+/-P) incompetence had a lower VFI (p<0.01) and RVF (p<0.02) than limbs with deep (+/-S+/-P) incompetence, and limbs with > or =2 incompetent perforator veins had a higher VFI (p<0.04) than those without perforators. All limbs with single-system incompetence were C(1-3,) whereas 78% of those with triple-incompetence were C(4-6) (p<0.01). The number of incompetent systems increased with clinical class (p<0.01).
The frequency of incompetence of more than one venous system increased with the clinical severity of venous disease and was accompanied by a 5-fold increase in the amount of reflux and a 50% rise in the RVF. The number of incompetent perforators per limb increased with the amount of reflux. The number of incompetent venous systems (superficial, deep, perforator) and perforator veins can be assessed by duplex ultrasound giving an objective indication of the functional severity of venous disease. In this way duplex ultrasound could be used to grade venous function in clinical practice as an alternative to APG measures which are less widely available.
本研究旨在评估深静脉、浅静脉和交通静脉联合功能不全（即多系统功能不全）对慢性静脉疾病（CVD）患者肢体静脉血流动力学及临床状况的影响。
对121例患者的132条肢体（16-C(1)；30-C(2)；20-C(3)；25-C(4)；21-C(5)；20-C(6)）进行研究。排除既往有静脉手术/硬化治疗史、外周动脉疾病、近期深静脉血栓形成（≤6个月）或无法配合检查者。评估CEAP临床分级。双功超声检查可根据以下情况进行分类：浅静脉（[S]）（±交通静脉[P]）或深静脉（[D]）（±S，±P）反流（>0.5秒）的存在情况；功能不全静脉系统的数量（单系统（[S/P/D]）、双系统（[S+P/S+D/P+D]）或三系统（[S+P+D]）），以及功能不全交通静脉的数量（[0/1/2/>或=3]）。采用空气容积描记法研究反流程度（静脉充盈指数[VFI]）、小腿泵射血分数[EF]和残余容积分数[RVF]。
三系统功能不全肢体的VFI（中位数6.68[四分位间距：4.7 - 9.7]ml/s）高于双系统功能不全肢体（4.5[2.1 - 7.4]ml/s），后者高于单系统功能不全肢体（1.3[0.69 - 2.3]ml/s）（p<0.01，Kruskal-Wallis检验）。尽管EF变化较小，但三系统功能不全肢体的RVF（39[30 - 51]%）高于单系统功能不全肢体（26[16 - 33]%）（p<0.01，Mann-Whitney检验）。浅静脉（±P）功能不全的肢体VFI（p<0.01）和RVF（p<0.02）低于深静脉（±S±P）功能不全的肢体，且交通静脉功能不全≥2条的肢体VFI（p<0.04）高于无交通静脉功能不全的肢体。所有单系统功能不全的肢体均为C(1 - 3)级，而三系统功能不全的肢体中78%为C(4 - 6)级（p<0.01）。功能不全系统的数量随临床分级增加（p<0.01）。
多个静脉系统功能不全的发生率随静脉疾病临床严重程度增加，同时反流程度增加5倍，RVF升高50%。每个肢体功能不全交通静脉的数量随反流程度增加。双功超声可评估功能不全静脉系统（浅静脉、深静脉、交通静脉）和交通静脉的数量，客观反映静脉疾病的功能严重程度。因此，双功超声可在临床实践中用于静脉功能分级，作为应用不太广泛的APG测量方法的替代方法。
