Chinchalongporn Wanchai, Tanmit Parichat, Pruekprasert Kanin, Prapassaro Tossapol, Hongku Kiattisak, Hahtapornsawan Suteekhanit, Puangpunngam Nattawut, Chinsakchai Khamin, Wongwanit Chumpol, Ruangsetakit Chanean, Sermsathanasawadi Nuttawut
Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Vasc Surg Venous Lymphat Disord. 2023 May;11(3):502-509. doi: 10.1016/j.jvsv.2022.11.006. Epub 2023 Feb 2.
The aim of the present study was to investigate the prevalence and predictors of combined >50% iliocaval venous obstruction (ICVO) and superficial venous reflux (SVR) in patients with chronic venous insufficiency (CVI) with a healed (C5) or an active (C6) venous leg ulcer (VLU).
We conducted a retrospective review of prospectively collected data from patients with CVI with CEAP (Clinical, Etiology, Anatomy, Pathophysiology) class C5 (healed ulcer) or C6 (active ulcer) with SVR who had been treated at our institution from February 2017 to January 2018. The demographic, clinical, and surgical data and duplex ultrasound and computed tomography venography findings were collected. We used OsiriX MD, version 2.9, software (Pixmeo SARL, Bernex, Switzerland) to measure the vein diameter via multiplanar reconstruction. The prevalence of combined >50% ICVO and SVR was evaluated, and univariate and multivariate analyses were performed to identify the independent predictors of >50% ICVO in patients with CVI and SVR.
A total of 79 limbs from 67 patients were enrolled. The mean age was 59.82 ± 12.86 years, the mean body mass index was 28.68 ± 6.41 kg/m, and 41.8% were men. The prevalence of >50% ICVO in the patients with SVR was 31.6%. Univariate analysis showed a history of deep vein thrombosis (DVT) in the affected leg (P = .001), a VLU in the left leg (P = .033), a history of a recurrent VLU (P = .038), and reversed flow in the superficial epigastric vein (P = .004) were significantly associated with >50% ICVO in patients with CVI and SVR. Multivariate analysis revealed a history of DVT in the affected leg (adjusted odds ratio [aOR], 8.31; 95% confidence interval [CI], 2.29-30.19; P = .001), a VLU in the left leg (aOR, 3.95; 95% CI, 1.18-13.19; P = .026), and a history of a recurrent VLU (aOR, 3.08; 95% CI, 1.02-9.32; P = .047) to be independently associated with combined >50% ICVO and SVR in patients with CVI.
The prevalence of combined >50% ICVO and SVR in patients with CVI and CEAP C5 or C6 was 31.6%. The independent predictors of combined >50% ICVO and SVR in those with CVI were a history of DVT in the affected leg, a VLU in the left leg, and recurrent VLUs.
本研究旨在调查慢性静脉功能不全（CVI）且伴有愈合（C5）或活动期（C6）下肢静脉溃疡（VLU）的患者中，合并>50%髂股静脉阻塞（ICVO）和浅静脉反流（SVR）的患病率及预测因素。
我们对2017年2月至2018年1月在我院接受治疗的CVI且伴有SVR的CEAP（临床、病因、解剖、病理生理）C5（愈合溃疡）或C6（活动期溃疡）患者的前瞻性收集数据进行了回顾性分析。收集了人口统计学、临床和手术数据以及双功超声和计算机断层扫描静脉造影结果。我们使用OsiriX MD 2.9版软件（Pixmeo SARL，伯尔尼，瑞士）通过多平面重建测量静脉直径。评估了合并>50% ICVO和SVR的患病率，并进行单因素和多因素分析以确定CVI和SVR患者中>50% ICVO的独立预测因素。
共纳入67例患者的79条肢体。平均年龄为59.82±12.86岁，平均体重指数为28.68±6.41kg/m，男性占41.8%。SVR患者中>50% ICVO的患病率为31.6%。单因素分析显示，患侧有深静脉血栓形成（DVT）病史（P = .001）、左腿有VLU（P = .033）、复发性VLU病史（P = .038）以及腹壁浅静脉反流（P = .004）与CVI和SVR患者中>50% ICVO显著相关。多因素分析显示，患侧有DVT病史（调整优势比[aOR]，8.31；95%置信区间[CI]，2.29 - 30.19；P = .001）、左腿有VLU（aOR，3.95；95% CI，1.18 - 13.19；P = .026）以及复发性VLU病史（aOR，3.08；95% CI，1.02 - 9.32；P = .047）与CVI患者中合并>50% ICVO和SVR独立相关。
CVI且CEAP C5或C6患者中合并>50% ICVO和SVR的患病率为31.6%。CVI患者中合并>50% ICVO和SVR的独立预测因素为患侧有DVT病史、左腿有VLU以及复发性VLU。
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