Association between the degree of iliac venous outflow obstruction by intravascular ultrasound and lower limbs venous reflux
J. Vasc. Surg. Venous Lymphat. Disord
; June 2023.
Article
in English
| CONASS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1437688
Responsible library:
BR79.1
ABSTRACT
OBJECTIVE:
This study aims to evaluate the association between the degree of iliac venous outflow obstruction (IVOO) identified by Intravascular Ultrasound (IVUS) and venous reflux presentation in lower limbs on Duplex Ultrasound (DU).METHODS:
Patients with bilateral chronic venous insufficiency, CEAP C3-6 (Clinical-Etiology-Anatomy-Pathophysiology classification), and with Visual Analogic Scale score for pain > 5, underwent DU for reflux evaluation deep venous system (reflux ≥ 1 s); superficial system, great saphenous vein (GSV) and small saphenous vein (SSV) (reflux ≥ 0.5 s); perforator system (reflux ≥ 0.35s). All patients underwent IVUS in the iliac venous territory. The area of the impaired venous segments was categorized as obstructions< 50% (Cat. 1); 50-79% (Cat. 2), and ≥ 80% (Cat. 3). Venous clinical severity scale (VCSS) and reflux multisegment score (RMS) were assessed.RESULTS:
51 patients (n=102 limbs; 50.53 ± 14.5 years, 6 men) were included. The predominant clinical severity CEAP class was C3 in 54/102 (52.9%) limbs. VCSS mean was 14.3 ± 6.7. Severe RMS (≥ 3) was registered in 63,4% of the limbs. In 51/102 limbs (50%) presented cat. 1, 27/102 (26.5%) cat. 2, and 24/102 (23.5%) cat. 3. Previous DVT was associated with critical obstruction (OR 3.65; 95% CI 1.29-10.38; p=0.015). Superficial and perforator venous systems had no association with the degree of iliac obstruction. Deep venous reflux (DVR) had a significant association with significative IVOO (obstruction ≥ 50%) (OR 6.44; 95% CI 2.19-18.93; p=0.001) and critical IVOO (obstruction ≥ 80%) (OR 4.57; 95% CI 1.70-12.27; p=0.003), and significant linear association with IVOO degree and reflux in femoral veins (p<0.001) and popliteal vein (p=0.008). Significant lesions had 5.76 (95% CI 2.46-13.50; p<0.001) more odds of happening in the left limb. After a multivariate analysis, DVR remained as predictor for significant and critical obstruction (p<0.003, p< 0.012; respectively). Left limb and previous DVT remained as predictors for IVOO ≥50% and IVOO≥ 80% (p<0.001, p=0.043; respectively)CONCLUSIONS:
There is a significant linear association between the degree of iliac venous outflow obstruction and reflux in the deep venous system on DU. Limbs with DVR, severe RMS, loss of respiratory variation on DU, and previous DVT, were more likely to be affected by IVOO ≥ 50%, especially with the left leg involvement.
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Collection:
National databases
/
Brazil
Database:
CONASS
/
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Main subject:
Ultrasonography, Doppler, Duplex
/
Lower Extremity
/
Iliac Vein
Type of study:
Prognostic study
/
Risk factors
Language:
English
Journal:
J. Vasc. Surg. Venous Lymphat. Disord
Year:
2023
Document type:
Article
Institution/Affiliation country:
Bahiana School of Medicine and Public Health/BR
/
Bahiana School of Medicine and Public Health, Department of Geriatrics, Hospital Santo Antônio - Obras Sociais Irmã Dulce/BR
/
Department of interventional radiology, Federal University of Bahia/BR
/
Department of vascular interventional radiology, Arizona Heart Institute/US
/
Department of vascular surgery, Instituto Dante Pazzanese de Cardiologia/BR