Primer yüzeyel venöz yetmezliğin dağılım paternlerinin belirlenmesinde gizli sınıf analizi

Amaç: Bu çalışmada Doppler haritalama sonuçlarına göre gizli sınıf analizine dayanarak, alt ekstremitenin kronik venöz hastalığının spesifik segmental dağılım paternleri belirlendi. Çalışma planı: Çalışmaya Eylül 2009 - Ağustos 2018 tarihleri arasında Doppler incelemesi için yönlendirilen daha önce tedavi edilmemiş, kronik venöz hastalığı olan 1,218 hastanın (536 erkek, 682 kadın; ort. yaş 45.4 yıl; dağılım, 21-87 yıl) toplam 1,871 alt ekstremitesi alındı. Alt ekstremitenin geri akışlı yüzeyel ven segmentleri 10 farklı anatomik lokasyonda haritalandı ve veri tabanına kaydedildi: safenofemoral kavşak ve proksimal büyük safen ven, orta ve distal kalça büyük safen ven, ön ve arka aksesuar safen venler, proksimal ve distal kalf büyük safen ven, safenopopliteal kavşak ve proksimal büyük safen ven, distal küçük safen ven ve Giacomini veni dahil olmak üzere intersafen venler. Tekrarlı incelemeler hariç tutuldu. Kronik venöz hastalığının muhtemel anatomik dağılım paternlerini belirlemek için gizli sınıf analizi uygulandı. Bulgular: Bayes bilgi kriterleri, geri akışlı segment dağılımına uyan üç gizli sınıf modeli ortaya çıkardı: %58.2’si (n=1089) safenofemoral kavşak dahil diz üstü büyük safen ven segmentleri (patern 1); %29.3’ü (n=548) diz altı büyük safen ven segmentleri (patern 2) ve %12.5’i (n=234) küçük safen ven segmentleri ve Giacomini veni dahil olmak üzere intersafen venler (patern 3). Kronik venöz hastalık dağılım paternleri arasında yaş veya cinsiyete özgü farklılıklar izlenmedi. Sonuç: Gizli sınıf analizi, çalışılan popülasyon içerisinde daha önce görülmemiş alt grupları belirleyerek, kronik venöz hastalığın geri akış paternlerinin sınıflandırılmasında yeni bir yaklaşım sunmaktadır. Gizli sınıfların belirlenmesi, venöz geri akışın farkı patofizyolojik temellerinin anlaşılmasını ve girişimler için daha uygun planlama yapılmasını sağlayabilir.

Latent class analysis for exploring distribution patterns of primary superficial venous insufficiency

Background: This study aims to identify specific segmental distributionpatterns of lower extremity chronic venous disease based on latent classanalysis of Doppler mapping results.Methods: A total of 1,871 lower extremities of 1,218 treatment-naïvepatients (536 males, 682 females; mean age 45.4 years; range, 21 to 87 years)with chronic venous disease referred for Doppler examination betweenSeptember 2009 and August 2018 were included. Refluxing superficialvenous segments of the lower extremities were mapped and recorded indatabase in 10 distinct anatomic locations as follows: saphenofemoraljunction and proximal greater saphenous vein, mid and distal thighgreater saphenous vein, anterior and posterior accessory saphenous veins,proximal and distal calf greater saphenous vein, saphenopopliteal junctionand proximal lesser saphenous vein, distal lesser saphenous vein, andintersaphenous veins including Giacomini’s vein. Repeated examinationswere excluded. The latent class analysis was applied to identify anypossible anatomic distribution patterns of chronic venous disease.Results: Bayesian information criteria revealed three latent class modelsfit for refluxing segment distribution as follows: 58.2% (n=1,089)were above-the-knee greater saphenous vein segments includingsaphenofemoral junction (pattern 1); 29.3% (n=548) were below-theknee greater saphenous vein segments (pattern 2); and 12.5% (n=234)were lesser saphenous vein segments and intersaphenous veins includingGiacomini’s vein (pattern 3). There was no age- or sex-specificdifferences in the chronic venous disease distribution patterns.Conclusion: The latent class analysis, by identifying previouslyunseen subgroups within the sampled population, provides a newapproach to classification of reflux patterns in chronic venous disease.Identification of latent classes may provide understanding of differentpathophysiological bases of venous reflux and more optimal planningfor interventions.

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