Lugli Marzia, Maleti Oscar, Iabichella M Letizia, Perrin Michel
Department of Cardiovascular Surgery, Hesperia Hospital, Modena, Italy -
Department of Cardiovascular Surgery, Hesperia Hospital, Modena, Italy.
Int Angiol. 2018 Apr;37(2):169-175. doi: 10.23736/S0392-9590.18.03901-9. Epub 2018 Jan 26.
C0S patients have symptoms of chronic venous disorders (CVDs), though an anatomical or pathophysiological explanation is lacking. C0 and C1 classified lower limbs can present with valve incompetence from the second to sixth generation of tributaries of saphenous veins despite the absence of a detectable saphenous truncal reflux. We hypothesized that C0S venous symptoms could stem from the second to sixth generation of saphenous tributaries and small veins that are not connected to the saphenous system. The aim was to explore these veins in C0S subjects and compare them with asymptomatic C0A subjects.
This was an open, controlled study enrolling 36 subjects, where C0S patients (N.=18) were compared with asymptomatic C0A subjects (N.=18). The VAS (visual analog scale) was used to assess leg pain. Veins were assessed using B-flow ultrasound (valve anatomy), continuous-wave (CW) Doppler (flow patterns), biomicroscopy (visualization of nutritional vessels), laser Doppler flowmetry (quantify supine microvascular perfusion) and quantitative digital photo-plethysmography (PPG) (measuring post-exercise venous refilling time [VRT]).
There were no significant differences between C0S and C0A subjects in terms of microvascular perfusion (laser-Doppler), nutritional vessels (biomicroscopy) and VRT (PPG). B-flow ultrasound was unable to acquire sufficient data in second generation saphenous tributaries. However, the CW Doppler identified two different flow patterns: uni- and bidirectional. Bidirectional flow was significantly (P=0.05) higher in C0S versus C0A patients.
CW Doppler, using a flat high-sensitivity probe, revealed the presence of a bidirectional flow that was significantly (P=0.05) higher in C0S than in control patients, suggesting the presence of reflux in non axial veins. These data give a new perspective on the management of C0S patients.
C0S患者有慢性静脉疾病（CVDs）的症状，尽管缺乏解剖学或病理生理学解释。C0和C1分级的下肢，即使在没有可检测到的大隐静脉主干反流的情况下，从大隐静脉第二到第六代分支也可能出现瓣膜功能不全。我们推测C0S静脉症状可能源于大隐静脉第二到第六代分支以及未与大隐静脉系统相连的小静脉。目的是在C0S受试者中探索这些静脉，并将其与无症状的C0A受试者进行比较。
这是一项开放的对照研究，纳入36名受试者，将C0S患者（n = 18）与无症状的C0A受试者（n = 18）进行比较。采用视觉模拟量表（VAS）评估腿部疼痛。使用B-flow超声（瓣膜解剖）、连续波（CW）多普勒（血流模式）、生物显微镜检查（营养血管可视化）、激光多普勒血流仪（量化仰卧位微血管灌注）和定量数字光电容积描记法（PPG）（测量运动后静脉再充盈时间[VRT]）评估静脉。
在微血管灌注（激光多普勒）、营养血管（生物显微镜检查）和VRT（PPG）方面，C0S和C0A受试者之间无显著差异。B-flow超声无法在大隐静脉第二代分支中获取足够的数据。然而，CW多普勒识别出两种不同的血流模式：单向和双向。C0S患者的双向血流显著高于C0A患者（P = 0.05）。
使用扁平高灵敏度探头的CW多普勒显示存在双向血流，C0S患者的双向血流显著高于对照组患者（P = 0.05），提示非轴向静脉存在反流。这些数据为C0S患者的管理提供了新的视角。
