Department of Anatomy, Sapienza University of Rome, Rome, Italy.
Angiology Department, MD Barbantini Hospital, Lucca, Italy.
J Vasc Surg Venous Lymphat Disord. 2022 May;10(3):689-696. doi: 10.1016/j.jvsv.2022.02.008. Epub 2022 Feb 23.
Calcifications in the subcutaneous layer (SCL) have been described by radiographic studies of legs with advanced chronic venous disease (CVD). However, SCL calcifications have rarely been included among the CVD-related changes. The aim of the present study was to evaluate the prevalence and morphology of SCL calcifications in legs with CVD of all grades of severity determined by ultrasound.
A total of 500 legs in 250 patients (148 women and 102 men; mean age, 51 years; range, 18-87 years) referred to our vascular clinic for symptoms and signs of CVD were included. After duplex ultrasound evaluation of the deep, superficial, and perforating veins, the skin and SCL were investigated using duplex ultrasound. Those patients with other possible causes of SCL calcification were excluded.
Using the C component of the CEAP (clinical, etiologic, anatomic, pathophysiologic) classification, 43 legs were classified as C1, 189 as C2, 34 as C3, 16 as C4A, 45 as C4B or C, 18 as C5, and 16 as C6. Varicose veins were reported in 273 legs, and lipodermatosclerosis in 79 legs. Subcutaneous calcifications were demonstrated in 35 of 361 legs with CVD in two different locations: the wall of superficial varicose veins and in subcutaneous tissue unrelated to the path of the superficial veins. Superficial veins calcifications were found in 12 of 273 legs with varicose veins (4.4%) and were found in older patients with severe varicose vein disease (grade 3 using the venous clinical severity score and disease duration >30 years). Subcutaneous tissue calcifications (STCs) were found in 24 of 95 legs with a more advanced CVD stage (C4A-C6). No STCs were found in legs with a C1, C2, or C3 class.
Superficial veins calcifications were found only in the legs with severe and long-lasting varicose veins and seemed to be related to chronic severe inflammation of the venous wall. STCs were independent of the vein wall and were found only in the damaged areas of legs with severe CVD (C4-C6). STCs are possibly related to chronic inflammation of the subcutaneous tissue. Their avulsion from the ulcer bed has been recommended to facilitate ulcer healing and prevent recurrence.
在下肢慢性静脉疾病（CVD）的放射学研究中描述了皮下层（SCL）的钙化。然而，SCL 钙化很少被包括在与 CVD 相关的变化中。本研究的目的是评估超声确定的所有严重程度的 CVD 下肢中 SCL 钙化的发生率和形态。
共纳入 250 例患者的 500 条腿（148 名女性和 102 名男性；平均年龄 51 岁；范围 18-87 岁），这些患者因 CVD 的症状和体征被转诊至我们的血管诊所。在对深静脉、浅静脉和穿支静脉进行双能超声评估后，使用双能超声检查皮肤和 SCL。排除了其他可能导致 SCL 钙化的患者。
根据 CEAP（临床、病因、解剖、病理生理）分类的 C 成分，43 条腿被分类为 C1，189 条腿为 C2，34 条腿为 C3，16 条腿为 C4A，45 条腿为 C4B 或 C，18 条腿为 C5，16 条腿为 C6。273 条腿有静脉曲张，79 条腿有脂硬皮病。在 361 条 CVD 下肢中有 35 条在两个不同部位显示皮下钙化：浅静脉曲张的壁和与浅静脉路径无关的皮下组织。在 273 条有静脉曲张的腿中，有 12 条（4.4%）发现浅静脉钙化，这些患者为患有严重静脉曲张疾病（静脉临床严重程度评分 3 级且病程>30 年）的老年患者。在 95 条具有更严重 CVD 阶段（C4A-C6）的下肢中发现了皮下组织钙化（STC）。在 C1、C2 或 C3 级的下肢中未发现 STC。
仅在严重且长期存在静脉曲张的下肢中发现浅静脉钙化，且似乎与静脉壁的慢性严重炎症有关。STC 与静脉壁无关，仅在严重 CVD（C4-C6）的下肢受损区域发现。STC 可能与皮下组织的慢性炎症有关。已建议将其从溃疡床撕脱以促进溃疡愈合并防止复发。
