Yeliz AKTÜRK, Aydın KURT, İlkay Sedakat İDİLMAN

İzole inkompetan perforan venlerin sonografik değerlendirilmesi ve yaş, cinsiyet, vücut kitle indeksi, CEAP sınıflandırması ile korelasyonu

Amaç: Bu çalışmada izole inkompetan perforan venlerin prevalansının belirlenmesi ve çeşitli faktörlerle (yaş, cinsiyet, lokasyon ve vücut kitle indeksi) ilişkisinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Toplam 485 hastaya ait 803 bacak dupleks ultrasonografi ile değerlendirilmiştir. Venöz yetmezliğin klinik ciddiyeti CEAP sınıflandırması ile yapılmıştır. Yüzeyel ve derin venöz yetmezliğin eşlik etmediği perforan venler, izole inkompetan perforan ven olarak tanımlanmıştır. Bulgular: 617 bacak CEAP 0-2, 186 bacak CEAP 3 ve üzeri olarak sınıflandırıldı. Yaş, cinsiyet, vücut kitle indeksi ve inkompetan perforan venler ile CEAP sınıflaması arasında anlamlı korelasyon mevcuttu. 803 bacaktan 22’sinde (%2.7) izole inkompetan perforan ven tespit edildi. Bu 22 bacakta toplam 25 adet izole inkompetan perforan ven vardı. Olguların 14’ü kadın, 5’i erkekti. Bu olguların tamamı CEAP 0-2 arasında sınıflandı. Olguların vücut kitle indeksi tüm hasta grubuna göre daha düşük bulundu. Sonuç: Bu çalışmanın sonuçları izole inkompetan perforan venlerin de venöz yetmezliğe yol açabileceğini göstermektedir. Vücut kitle indeksi, izole inkompetan perforan ven izlenen grupta daha düşük bulunmuştur. Bu nedenle hasta kilosunda yada vücut kitle indeksindeki artışın, izole perforan ven yetmezliği gelişimine anlamlı yatkınlık oluşturmadığı sonucuna varılabilir.

Anahtar Kelimeler:

perforan, ven

Sonographic identification of isolated incompetent perforating veins and their correlation with age, sex, body mass index and CEAP classification

Purpose: Isolated incompetent perforating veins (IPVs) are poorly discussed in the literature and their importance and prevalence is unknown. This study aims to assess the prevalence and their relation with several factors; age, sex, location and body mass index (BMI). Materials and Methods: A total of 803 limbs of 485 patients were evaluated with duplex ultrasonography. The clinical severity of the affected limbs were assessed according to CEAP classification. Incompetent perforating veins were considered isolated if neither superficial nor deep venous system reflux were associated. Results: 617 legs were classified as CEAP 0-2, 186 legs were classified as CEAP 3 or higher. There was a significant correlation with age, sex, BMI, incompetent perforating veins and CEAP stage. 22 of 803 legs (2.7%) have been shown to have isolated incompetent perforating veins. Total of 25 isolated incompetent perforating veins were detected in these 22 legs (19 patients; 14 females, 5 males). All patients with isolated incompetent perforating veins had CEAP stage 0-2. The mean BMI of these patients was lower than the whole patients groups. Conclusion: The results of this study show that isolated IPVs may also be a cause of venous insufficiency. It may be inferred that the increase in the patients' weights or BMIs does not lead to development of isolated incompetent perforating veins because the BMI of the patients with isolated incompetent perforating veins are found to be lower.

Keywords:

perforating vein, incompetent,

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1. Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Review. Circulation. 2005;111:2398-409.
2. Allan PL, Bradbury AW, Evans CJ, Lee AJ, Vaughan Ruckley C et al. Patterns of reflux and severity of varicose veins in the general population-Edinburgh Vein Study. Eur J Vasc Endovasc Surg. 2000;20:470-7.
3. Delis KT. Leg perforator vein incompetence: functional anatomy. Radiology. 2005;235:327-34.
4. Labropoulos N, Landon P, Tiongson J. The impact of Duplex scanning in phlebology. Dermatol Surg. 2002;28:1-5.
5. Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15:175-84.
6. Chiesa R, Marone EM, Limoni C, Volonte M, Schaefer E, Petrini O. Chronic venous insufficiency in Italy: the 24-cities cohort study. Eur J Vasc Endovasc Surg. 2005;30:422-9.
7. Delis KT, Husmann M, Kalodiki E, Wolfe JH, Nicolaides AN. In situ hemodynamics of perforating veins in chronic venous insufficiency. J Vasc Surg. 2001;33:773-82.
8. Labropoulos N, Mansour MA, Kang SS, Glovicki P, Baker WH. New insights into perforator vein incompetence. Eur J Vasc Endovasc Surg. 1999;18:228-34.
9. Ibegbuna V, Delis KT, Nicolaides AN. Haemodynamic and clinical impact of superficial, deep and perforator vein incompetence. Eur J Vasc Endovasc Surg. 2006;31:535-41.
10. Barrellier M.T. Physiologie des perforantes. Phlébologie. 1997;50:653-7.
11. Delis KT, Ibegbuna V, Nicolaides AN, Lauro A, Hafez H. Prevalence and distribution of incompetent perforating veins in chronic venous insufficiency. J Vasc Surg 1998;28:815-25.
12. Stuart WP, Adam DJ, Allan PL, Ruckley V, Bradbury AW. The relationship between the number, competence and diameter of medial calf perforating veins and the clinical status in healthy subjects and patients with lower limb venous disease. J Vasc Surg. 2000;32:138-43.
13. Labropoulos N, Tassiopoulos AK, Bhatti AF, Leon L. Development of reflux in the perforator veins in limbs with primary venous disease. J Vasc Surg. 2006;43:558-62.
14. Kleine-Wegel, Biedermann H, Fraedrich G. The role of perforating vein dissection in the treatment concept of venous ulcers--myths and evidence. Vasa. 2002;31:225-9.
15. Eklöf B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL et al. Revision of the CEAP classification for chronic venous disorders. Consensus statement. J Vasc Surg. 2004;40:1248-52.
16. Neglen P, Egger JF, Olivier J, Raju S. Hemodynamic and clinical impact of ultrasound-derived venous reflux parameters. J Vasc Surg. 2004;40:303-10.
17. Sandri JL, Barros FS, Pontes S, Jacques C, Salles-Cunha S. Diameter reflux relationship in perforating veins of patients with varicose veins. J Vasc Surg. 1999;30:867-75.
18. Neumyer MM. Ultrasound diagnosis of venous insufficiency. In: Introduction to vascular ultrasonography, 5th edition. Elsevier, Inc. 2005;479-500.
19. O'Donnell TF Jr, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL et al. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery ® and the American Venous Forum. J Vasc Surg. 2014;60:3-59. doi: 10.1016/j.jvs.2014.04.049.
20. Bradbury A, Evans CJ, Allan P, Lee AJ, Ruckley V, Fowkes FGR. The relationship between lower limb symptoms and superficial and deep venous reflux on duplex ultrasonography: The Edinburg Vein Study. J Vasc Surg. 2000;32:921-31.
21. Bello M, Scriven M, Hartshorne T, Bell PR, Naylor AR, London NJ. Role of superficial venous surgery in the treatment of venous ulceration. Br J Surg. 1999;86:755-9.
22. Labropoulos N, Delis K, Nicolaides AN, Leon M, Ramaswami G. The role of the distribution and anatomic extent of reflux in the development of signs and symptoms in chronic venous insufficiency. J Vasc Surg. 1996;23:504-10.
23. Eidson JL, Bush RL. Diagnosis and current management of incompetent perforator veins. Semin Vasc Surg. 2010;23:113-7.
24. Delis KT. Perforator vein incompetence in chronic venous disease: a multivariate regression analysis model. J Vasc Surg. 2004;40:626-33.
25. Shami SK, Sarin S, Cheatle TR, Scurr JH, Smith PD. Venous ulcers and the superficial venous system. J Vasc Surg. 1993;17:487-90.
26. Vashist MG, Malik V, Singhal N. Role of Subfascial Endoscopic Perforator Surgery (SEPS) in management of perforator incompetence in varicose veins : a prospective randomised study. Indian J Surg. 2014;76:117–23.
27. Boersma D, Smulders DL, Bakker OJ, van den Haak RF, Verhoeven BA, Koning OH. Endovenous laser ablation of insufficient perforating veins: energy is key to success. Vascular. 2016;24:144-9.