The RANE Center, St. Dominic's Memorial Hospital, Jackson, Miss.
The RANE Center, St. Dominic's Memorial Hospital, Jackson, Miss.
J Vasc Surg Venous Lymphat Disord. 2019 Sep;7(5):706-714. doi: 10.1016/j.jvsv.2019.03.006. Epub 2019 Jun 10.
Microvascular venous hypertension has emerged as a central feature of chronic venous disease (CVD). Yet, the incidence and severity of peripheral venous hypertension in the clinical setting have not been reported. This is an observational study of venous hypertension in the lower limb of a large cohort of patients with suspected CVD referred to a single referral center during a 16-year period.
Clinical and venous laboratory test data for 8868 limbs of 5792 patients with CVD symptoms seen from 1999 to 2015 were analyzed. Subset A limbs had a mix of obstruction/reflux or neither (n = 4132). These are limbs in which duplex ultrasound reflux (yes/no) status is known. The incidence and severity of obstruction in these limbs are unknown as tests of obstruction were not routinely performed. Subset B limbs had central obstruction (n = 159). These are limbs with intravascular ultrasound-proven stenosis in the iliac veins that was corrected by stent placement. Reflux was assessed by duplex ultrasound and air plethysmography (venous filling index [VFI]). Pressure measurements included supine venous pressure, erect venous pressure, and ambulatory venous pressure (AMVP). Pressure measurements are categorized according to Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class, reflux and obstruction with Venn distributions of prevalence.
All pressures (supine, erect, and ambulatory) trended worse in higher CEAP clinical classes. Supine foot venous pressures were elevated in 70% and 76% of subsets A and B, respectively. A positive association between elevated supine pressures and reflux could not be shown in this study. Supine foot venous pressure did not worsen with increasing reflux in the two subsets, but erect foot venous pressure did. Elevated supine pressures were associated with obstruction in subset B. AMVP worsened in most higher reflux categories. Ambulatory venous hypertension was dominantly associated (Venn distribution) with reflux, less commonly with obstruction.
Supine venous hypertension is associated with obstruction and does not worsen with reflux. In contrast, erect foot venous pressure worsens in severe reflux categories. Ambulatory venous hypertension worsens in higher CEAP clinical classes. It worsens with increasing reflux. AMVP is dominantly associated (Venn distribution) with reflux, not obstruction.
微血管静脉高压已成为慢性静脉疾病（CVD）的一个核心特征。然而，外周静脉高压在临床环境中的发生率和严重程度尚未得到报道。这是一项对 1999 年至 2015 年期间在单一转诊中心就诊的疑似 CVD 患者的大队列下肢静脉高压的观察性研究。
分析了 5792 例 CVD 症状患者的 8868 条肢体的临床和静脉实验室检查数据。亚组 A 肢体既有阻塞/反流，也有无阻塞/反流（n=4132）。这些是已知有双功能超声反流（有/无）状态的肢体。这些肢体的阻塞程度和严重程度尚不清楚，因为没有常规进行阻塞测试。亚组 B 肢体存在中心性阻塞（n=159）。这些是通过血管内超声证实髂静脉狭窄并通过支架置入纠正的肢体。反流通过双功能超声和空气容积描记法（静脉充盈指数[VFI]）进行评估。压力测量包括仰卧位静脉压、直立位静脉压和运动静脉压（AMVP）。压力测量根据临床、病因、解剖和病理生理学（CEAP）临床分类进行分类，反流和阻塞的流行情况用 Venn 分布表示。
所有压力（仰卧位、直立位和运动位）在较高的 CEAP 临床分类中均呈上升趋势。亚组 A 和 B 的仰卧位足部静脉压分别升高了 70%和 76%。本研究未能显示升高的仰卧位压力与反流之间存在正相关。在这两个亚组中，随着反流的增加，仰卧位足部静脉压并未恶化，但直立位足部静脉压却恶化了。在亚组 B 中，升高的仰卧位压力与阻塞有关。在大多数反流程度较高的类别中，AMVP 恶化。运动性静脉高压主要与反流相关（Venn 分布），与阻塞相关较少。
仰卧位静脉高压与阻塞有关，与反流无关。相反，严重反流程度会使直立位足部静脉压恶化。在较高的 CEAP 临床分类中，运动性静脉高压恶化。它随反流的增加而恶化。AMVP 主要与反流相关（Venn 分布），而不是阻塞。
