Shammas Nicolas W, Knowles Mary F, Shammas W John, Hauber William, Shammas Gail A, Green Melissa J, Dokas Julie
Research Director, Midwest Cardiovascular Research Foundation, 1622 E. Lombard Street, Davenport, IA 52803 USA.
J Invasive Cardiol. 2016 Sep;28(9):370-2. Epub 2016 Jul 15.
The optimal technique to detect venous reflux requires a patient to be standing with weight on one leg while the other leg is scanned for superficial venous reflux (standing position [SP] technique). This represents a significant hardship for a subset of patients who are unable to stand and adequately maintain their balance. This study examines the predictability of identifying venous reflux using a reverse Trendelenburg 60° (RT-60) when compared with the SP in the great saphenous vein (GSV) and small saphenous vein (SSV).
After obtaining informed consent, consecutive symptomatic patients were studied for venous reflux in the GSV and SSV using both SP and RT-60 during the same visit to the diagnostic laboratory. Reflux was analyzed in both SSV (proximal, mid, and distal segments) and GSV (proximal, mid-thigh, distal-thigh, and below-the-knee segments). Reflux was defined as duration of retrograde venous flow >0.5 seconds following rapid cuff deflation. Patients with heart failure, prior limb surgery, history of deep vein thrombosis, cellulitis, known severe pulmonary hypertension, end-stage renal disease, lymphedema, or trauma were excluded. We calculated the percentage of segments that had reflux on RT-60 out of those with reflux on SP, and the percentage of no reflux on RT-60 out of those with no reflux on SP.
A total of 33 patients (56 limbs, 252 segments) were included in this analysis. Mean age was 65 ± 12.4 years and 54.5% were male. All patients were symptomatic (mean clinical, etiology, anatomy, pathophysiology [CEAP] class, 3.5). Deep venous reflux was present in 3/33 patients (9.1%). Of the patients enrolled, 93.9% noted worsening swelling of their lower extremities with standing up and 53.6% of limbs were CEAP class IV or higher. All limbs with no reflux on RT-60 had no reflux using the SP and 48/49 limbs (98%) with reflux on SP also had reflux on the RT-60.
RT-60 appears to capture 98% and 100% of positive and negative reflux scans on SP, respectively, when GSV and SSV were evaluated. These findings, however, may not apply to the remainder of the venous system of the lower extremity, where SP may continue to be the standard for venous reflux evaluation.
检测静脉反流的最佳技术要求患者单腿站立负重，同时对另一条腿进行浅静脉反流扫描（站立位[SP]技术）。对于一部分无法站立并充分保持平衡的患者来说，这是一项很大的困难。本研究旨在探讨与SP相比，使用60°反向特伦德伦伯卧位（RT-60）识别大隐静脉（GSV）和小隐静脉（SSV）中静脉反流的可预测性。
在获得知情同意后，对连续的有症状患者在同一次就诊于诊断实验室时，使用SP和RT-60对GSV和SSV中的静脉反流进行研究。对SSV（近端、中段和远端节段）和GSV（近端、大腿中段、大腿远端和膝下段节段）的反流情况进行分析。反流定义为快速袖带放气后逆行静脉血流持续时间>0.5秒。排除患有心力衰竭、既往肢体手术史、深静脉血栓形成史、蜂窝织炎、已知严重肺动脉高压、终末期肾病、淋巴水肿或创伤的患者。我们计算了RT-60上有反流的节段占SP上有反流节段的百分比，以及RT-60上无反流的节段占SP上无反流节段的百分比。
本分析共纳入33例患者（56条肢体，252个节段）。平均年龄为65±12.4岁，男性占54.5%。所有患者均有症状（平均临床、病因、解剖、病理生理[CEAP]分级为3.5级）。33例患者中有3例（9.1%）存在深静脉反流。在纳入的患者中，93.9%的患者表示站立时下肢肿胀加重，53.6%的肢体为CEAP IV级或更高。RT-60上无反流的所有肢体在使用SP时也无反流，SP上有反流的49条肢体中有48条（98%）在RT-60上也有反流。
在评估GSV和SSV时，RT-60似乎分别能捕捉到SP上98%的阳性反流扫描和100%的阴性反流扫描。然而，这些发现可能不适用于下肢静脉系统的其余部分，在那里SP可能仍然是静脉反流评估的标准。
