Department of Surgery & Cancer, Imperial College London, Charing Cross Hospital, London, UK.
Department of Surgery & Cancer, Imperial College London, Charing Cross Hospital, London, UK.
Eur J Vasc Endovasc Surg. 2019 Jun;57(6):851-857. doi: 10.1016/j.ejvs.2019.01.024. Epub 2019 Mar 5.
OBJECTIVE/BACKGROUND: The aim was to summarise the evidence for the relationship between vein diameters and clinical severity, and elucidate the relationship between diameters and health related quality of life (HRQoL) METHODS: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The MEDLINE and Embase databases were searched from 1946 to 31 August 2018. Reference lists of included studies were searched for further relevant papers. Full text studies in English reporting the relationship between great and small saphenous vein diameters and clinical severity and/or HRQoL scores measured using validated instruments were included. All study designs were included. Studies that did not include relationships between these parameters, non-English studies, and studies focusing on non-truncal veins were excluded. Two reviewers independently performed the study selection, data extraction, and risk of bias assessment.
Eleven eligible studies were identified, reporting on 2,732 limbs (range 22-681). Four studies correlated truncal vein diameter with both clinical severity and HRQoL, while seven reported only on clinical severity measures. Multiple instruments were used to quantify HRQoL and clinical severity. Seven studies assessed the relationship with CEAP class, with the majority observing a positive correlation between vein diameter and disease severity. Four studies found weak correlations with VCSS, with one showing correlations with VCSS components. No significant relationship between diameters and HRQoL scores was reported. One study also revealed no correlation with Aberdeen Varicose Vein Questionnaire improvements post-treatment. The majority of studies failed to include C and C participants.
While further studies are required to improve the level of evidence, the existing literature suggests that truncal vein diameters correlate with clinical severity. Diameters are a poor predictor of HRQoL, with no relationship to patients' perceived impact of chronic venous disease. As such, vein diameter should not be used as a measure to decide who needs venous intervention.
目的/背景：本研究旨在总结静脉直径与临床严重程度之间关系的证据，并阐明直径与健康相关生活质量（HRQoL）之间的关系。
按照 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行系统评价。检索了 MEDLINE 和 Embase 数据库，检索时间为 1946 年至 2018 年 8 月 31 日。纳入研究的参考文献列表中也搜索了其他相关文献。纳入的研究均为英文，报告了大隐静脉和小隐静脉直径与临床严重程度和/或使用经过验证的工具测量的 HRQoL 评分之间的关系。所有研究设计均被纳入。未纳入这些参数之间关系的研究、非英文研究以及专注于非主干静脉的研究被排除在外。两名审查员独立进行了研究选择、数据提取和偏倚风险评估。
确定了 11 项符合条件的研究，共报告了 2732 条肢体（范围 22-681）。四项研究将主干静脉直径与临床严重程度和 HRQoL 相关联，而七项研究仅报告了临床严重程度测量结果。多种工具用于量化 HRQoL 和临床严重程度。七项研究评估了与 CEAP 分级的关系，大多数研究观察到静脉直径与疾病严重程度之间存在正相关。四项研究发现与 VCSS 之间存在弱相关性，一项研究显示与 VCSS 组成部分之间存在相关性。没有报告直径与 HRQoL 评分之间存在显著相关性。一项研究还表明，治疗后与 Aberdeen 静脉曲张学问卷（Aberdeen Varicose Vein Questionnaire，AVVQ）改善之间无相关性。大多数研究未能纳入 C 和 C 期患者。
尽管需要进一步研究来提高证据水平，但现有文献表明主干静脉直径与临床严重程度相关。直径是 HRQoL 的一个不佳预测指标，与患者对慢性静脉疾病的影响感知无关。因此，静脉直径不应作为决定谁需要静脉干预的衡量标准。
