Department of Clinical and Scientific, International Institution of Health Care and Additional Education Research Institute of Clinical Medicine, Irkutsk, Russia; Department of Phlebology, LLC Vein Center "Antireflux", Surgut, Russia.
Jobst Vascular Institute, Toledo, Ohio; University of Michigan, Ann Arbor, Mich.
J Vasc Surg Venous Lymphat Disord. 2022 Jan;10(1):69-74. doi: 10.1016/j.jvsv.2021.04.010. Epub 2021 May 4.
Venous reflux is the sole pathophysiologic process in primary chronic venous disease and its progression. We hypothesize that the reflux volume (RV) increases along a great saphenous vein (GSV) in a distal direction. We aimed to compare simultaneously measured RV in the upper and lower GSV segments in a thigh.
Patients meeting the inclusion criteria were enrolled (70 limbs of patients with primary incompetence of the GSV) and consented to this participate in the single-center study. Patients were stratified into two groups: incompetent terminal valve and competent terminal valve. A cross-section area of the GSV was measured at the upper (CSA, cm) and distal (CSA, cm) points in a thigh. A cross-section area of each tributary that joined with the GSV between the points was measured, and their total cross-section area was calculated (CSA). After a distal cuff compression-decompression maneuver, a time average mean velocity (cm/s) and reflux duration (seconds) were measured at both points simultaneously. The RV (mL) was calculated for each point (RV and RV). The difference in absolute values of RV (mL) and its relative changing (RV, %) were calculated.
The main result was RV increases caudally from saphenofemoral junction (SFJ) to the knee level (RV 12.7 ± 8.4 and RV 20.5 ± 14.0 mL; P < .0001). There was no difference between CSA and CSA (0.34 ± 0.17 and 0.33 ± 0.17 cm, respectively; P = .9) but the time average mean velocity was a statistically significant different in two points (7.3 ± 3.9 and 11.4 ± 5.7 cm/s, respectively; P < .0001). All of the tributaries between the points were competent.
The RV in the GSV increases caudally from SFJ to the knee level. The observed RV was an aggregate of all GSV tributaries' flow and the flow via the SFJ if incompetent.
静脉反流是原发性慢性静脉疾病及其进展的唯一病理生理过程。我们假设反流量（RV）沿大隐静脉（GSV）向远端方向增加。我们旨在比较大腿中GSV 上段和下段同时测量的 RV。
符合纳入标准的患者（70 条原发性 GSV 功能不全的肢体）入组并同意参与这项单中心研究。患者分为两组：终末瓣膜功能不全和终末瓣膜功能正常。在大腿处测量 GSV 的近段（CSA，cm）和远段（CSA，cm）的横截面积。测量位于两点之间与 GSV 汇合的每个属支的横截面积，并计算其总横截面积（CSA）。在远段袖口压缩-减压操作后，同时在两点测量时间平均平均速度（cm/s）和反流持续时间（秒）。计算每个点的 RV（mL）（RV 和 RV）。计算 RV（mL）绝对值的差异及其相对变化（RV，%）。
主要结果是 RV 从隐股交界处（SFJ）向膝关节水平逐渐增加（RV 12.7±8.4 和 RV 20.5±14.0 mL；P<.0001）。CSA 和 CSA 之间没有差异（分别为 0.34±0.17 和 0.33±0.17 cm；P=.9），但两点的时间平均平均速度有统计学差异（分别为 7.3±3.9 和 11.4±5.7 cm/s；P<.0001）。两点之间的所有属支均为功能正常。
从 SFJ 到膝关节水平，GSV 的 RV 向远端逐渐增加。观察到的 RV 是所有 GSV 属支的流量和如果功能不全则通过 SFJ 的流量的总和。
