Venous ultrasonography findings and clinical correlations in 104 Thai patients with chronic venous insufficiency of the legs

<p><b>INTRODUCTION</b>The pattern of venous reflux in Thai patients with chronic venous insufficiency (CVI) was studied in correlation with clinical manifestations.</p><p><b>METHODS</b>Ultrasonography findings and clinical data were prospectively collected and retrospectively reviewed.</p><p><b>RESULTS</b>CVI was found in 104 legs of 79 patients (mean age 59.8 ± 12.5 years; C4: 24.1%, C5: 8.9%, C6: 67.1%). 6.7% of the legs had a history of deep vein thrombosis (DVT). The prevalence of superficial vein reflux (SVR), deep vein reflux (DVR), and combined SVR and DVR in 90 legs without previous venous surgery was 82.2%, 63.3% and 57.8%, respectively. In legs with SVR, the prevalence of great saphenous vein reflux (GSVR), small saphenous vein reflux (SSVR), and combined GSVR and SSVR was 91.9%, 33.8% and 25.7%, respectively. 77.0% of SVR involved the calf segment. For medial ulceration, 79.6% had GSVR and 35.2% had SSVR. For lateral ulceration, 46.7% had SSVR and 33.3% had isolated GSVR. Pulsatile venous signal was found in 3.3% of legs. In 17 legs with ulceration after previous surgical treatment, calf vein reflux (residual calf great saphenous vein or small saphenous vein) was found in 13 (76.5%) legs.</p><p><b>CONCLUSION</b>Calf vein reflux plays an important role in CVI and in patients with recurrent ulceration after previous superficial venous surgery. Although GSVR was present in most patients with CVI in the legs, SSVR may present in one-third of patients, especially those with lateral ulceration. The high prevalence of DVR in the absence of DVT and the presence of a pulsatile venous signal in some patients highlight the incomplete understanding of CVI aetiology.</p>

Peripheral Arterial Disease of Lower Extremities, PAD

Abstract Peripheral Arterial Disease of Lower Extremities, PAD Burapa                 Kanchanabat                 MD Waigoon               Stapanavatr                  MD Yoothapong         Sangpayup                     MD Pong                     Kanchanasuttirak          MD           Peripheral arterial disease (PAD) commonly affects lower Extremities. The main cause is atherosclerosis. There is no available incidence data in Thai population. It is a major cause of lower limb amputation. PAD could be categorized as chronic arterial occlusion, presenting with chronic ulcer, gangrene or rest pain and acute arterial occlusion which leading to rapid limb loss. PAD is easily diagnosed by history taking, physical examination and measurement of ankle/brachial index (ABI). Treatment options are depends on its severity and the patient's condition. Risk factors modification, antiplatelets, anti-coagulants, thrombolytics and arterial bypass surgery may consider for appropriate patients. Vajira Med J 2007 ; 51 : 217 - 225

Pattern and Prevalence of Venous Reflux in Patients with Lower Extremity Chronic Venous Insufficiency

Abstract Pattern and Prevalence of Venous Reflux in Patients with Lower Extremity Chronic Venous Insufficiency Burapa        Kanchanabat                 MD Yuttapong Wongmahisorn              MD Waigoon     Stapanavatr                  MD Pong           Kanchanasuthiruk         MD Anan           Manomaiphiboon                     MD, MSc (Clinical Epidemiology) Department of surgery, BMA Medical College and Vajira Hospital. Objective: To study the pattern and prevalence of deep and superficial venous reflux in chronic venous insufficiency (CVI) patients. Study design: Prospective descriptive study. Subjects: A total of 30 CVI patients (40 legs) with Clinical Etiological Anatomical Pathological (CEAP) classification of ≥ C4 who attended the vascular clinic at BMA Medical College and Vajira Hospital between October 2006 and December 2007 were prospectively enrolled. Methods: The history and physical examination of the patients were recorded. Reflux of common femoral, superficial femoral, popliteal and greater saphenous veins were examined in all patients with the duplex doppler ultrasonography. The lesser saphenous veins were examined in 17 patients (22 legs). The reflux time more than 500 milliseconds were used for reflux diagnosis. Main outcome measures: Pattern and prevalence of venous reflux in lower extremity CVI patients. Results: In 30 CVI patients, there were 15 male and 15 female patients, with the mean age of 56.2 ± 12.5 years. In 30 legs (22 patients), which had not been operated for greater saphenous venous stripping, the most common pattern of reflux was combined superficial and deep vein reflux which were found in 80.0%. The isolated superficial and deep vein reflux were 6.7% and 10.0% respectively. Overall, deep and superficial vein reflux were found in 90.0% and 86.7% respectively. In 10 legs (8 patients) that had previous greater saphenous venous stripping, the incidence of deep vein reflux was 80.0%. The lesser saphenous veins were examined in 22 legs (17 patients), and reflux was found in 13 legs (59.0%). Conclusion: In patients who had not had greater saphenous venous stripping, the incidence of deep venous reflux was 90.0% and the incidence of superficial venous reflux was 86.7%. The common pattern was combined superficial and deep vein reflux, which were found in 90.0%. The isolated reflux was uncommon and found in only 6.7% and 10.0% for superficial vein and deep vein respectively. Vajira Med J 2008 ; 52 : 119 - 128