Sureshkumar Sathasivam, Vignesh Narayan, Venkatachalam J, Vijayakumar Chellappa, Sudharsanan Sundaramurthi
Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Cureus. 2018 Jan 5;10(1):e2026. doi: 10.7759/cureus.2026.
Background The color Doppler, a better investigation to identify the perforators objectively has replaced the clinical examination for the same. However, this has led to a significant number of negative explorations and cosmetic disfigurement. Objective To compare the efficacy of the clinical tests combined with the color Doppler versus color Doppler alone to identify the perforator incompetence during the surgery for primary varicose veins of the lower limb. Methods This was a prospective analytical study, including 61 lower limb varicose vein patients who belonged to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) class four-six, planned for the surgical treatment for perforator incompetence, excluding those requiring additional vascular or nonvascular procedure, recurrent varicose veins and those who had injection sclerotherapy prior to the surgery. The clinical tests, including Trendelenburg's test, multiple tourniquet tests and, the Fegan's tests were performed and incompetent perforators were marked on a template as 'C' to indicate the clinically positive perforator incompetence. The patients were then examined with the color Doppler ultrasound and the pathological incompetent perforators were marked as 'D'. The surgical management of the perforator incompetence was done by stab ligation. The incision was made in the color Doppler 'D' marked sites as it has been the standard protocol. The number of incompetent perforators identified during the surgical exploration were categorized as 'D' positive or 'C' and 'D' positive and were recorded in the specified proforma. Results It was found that the mean number of the perforator incompetence identified by the color Doppler alone was 8.2 whereas during the surgery, only a mean of six perforators was identified, leading to 20 unnecessary explorations per 10 patients (8.2 vs. 6; mean difference 2.229; P <0.001). The mean number of the perforator incompetence identified by the color Doppler combined with the clinical tests was 4.5 and during the surgery, a mean of four perforators was identified (4.5 vs. 4; mean difference 0.377; P <0.001). The color Doppler combined with the clinical examination lead to only four unnecessary explorations per 10 patients. Conclusion A combination of both the clinical tests and the color Doppler ultrasound has a higher accuracy in detecting perforator incompetence and can reduce the number of negative explorations by the rate of 16 unnecessary explorations per 10 patients.
彩色多普勒能更客观地识别穿支静脉，已取代了对此的临床检查。然而，这导致了大量的阴性探查和美容缺陷。目的：比较临床检查联合彩色多普勒与单纯彩色多普勒在下肢原发性静脉曲张手术中识别穿支静脉功能不全的疗效。方法：这是一项前瞻性分析研究，纳入61例下肢静脉曲张患者，属于临床-病因-解剖-病理生理（CEAP）分级四至六级，计划行穿支静脉功能不全的手术治疗，排除那些需要额外血管或非血管手术、复发性静脉曲张以及术前已行注射硬化治疗的患者。进行临床检查，包括Trendelenburg试验、多重止血带试验和Fegan试验，将功能不全穿支静脉在模板上标记为“C”，表示临床阳性穿支静脉功能不全。然后对患者进行彩色多普勒超声检查，将病理上功能不全的穿支静脉标记为“D”。穿支静脉功能不全的手术处理采用缝扎术。按照标准方案，在彩色多普勒标记为“D”的部位做切口。手术探查中识别出的功能不全穿支静脉数量分为“D”阳性或“C”和“D”阳性，并记录在指定表格中。结果：发现单纯彩色多普勒识别出的功能不全穿支静脉平均数量为8.2条，而手术中仅平均识别出6条穿支静脉，每10例患者导致20次不必要的探查（8.2对6；平均差值2.229；P<0.001）。彩色多普勒联合临床检查识别出的功能不全穿支静脉平均数量为4.5条，手术中平均识别出4条穿支静脉（4.5对4；平均差值0.377；P<0.001）。彩色多普勒联合临床检查每10例患者仅导致4次不必要的探查。结论：临床检查和彩色多普勒超声联合应用在检测穿支静脉功能不全方面具有更高的准确性，可将每10例患者中不必要探查的数量减少16次。
