Validation of Venous Clinical Severity Score (VCSS) with Other Venous Severity Assessment Tools: Analysis from the National Venous Screening Program

Abstract

pattern of venous reflux on duplex ultrasound imaging in patients with primary CVD.Methods: A retrospective analysis was performed of duplex ultrasound reports of patients with CVD in one institution between January 1, 2000, and August 31, 2009. Excluded were patients with secondary CVD and limbs previously treated with open surgery, endovenous ablation, and injection sclerotherapy, as were patients whose scan reports contained inadequate information. Subgroup analysis was performed to compare the pattern of venous reflux in men and women, and three age groups (Ͻ30, 30-60, Ͼ60 years). The 2 test was used. P Ͻ .05 was considered significant.Results: The Fig summarizes the limbs that were included and excluded. After exclusion, 2888 patients (1084 men and 1804 women; mean age, 53.8 years; range, 11.9-101.2 years) were included for analysis. Saphenofemoral junction (SFJ) reflux was demonstrated in 53% of limbs (2137 of 4020; men, 58%; women, 50%; P Ͻ .0001). No significant difference was noticed in the proportion of SFJ incompetence between age groups (P ϭ .9866). Great saphenous vein (GSV) reflux was found in 82% of limbs (3303 of 4020; men, 84%; women, 81%; P ϭ .0044). No significant difference was observed in the proportion of GSV incompetence between age groups (P ϭ .2035). Saphenous-popliteal junction (SPJ) reflux was found in 22% of limbs (871 of 4020; men, 21%; women, 22%; P ϭ .2829). The percentage of SPJ incompetence was not significantly different between age groups (P ϭ .0687). Small saphenous vein (SSV) incompetence was shown in 30% of limbs (1224 of 4020; men, 33%; women, 29%; P ϭ .0117). A significant difference was also noted in the proportion of SSV reflux in between age groups (P ϭ .0167). Of 1883 limbs with a competent SFJ, 1280 (68%) had refluxing GSV, and 51% of limbs (762 of 1479) with competent GSV above the knee showed GSV reflux below the knee. Five percent of limbs with an incompetent SFJ and distal GSV had a competent proximal GSV (81 of 1621). Furthermore, 20% of limbs (630 of 3149) with competent SPJ demonstrated refluxing SSV.Conclusions: Reflux does not invariably originate at junctions of patients with primary CVD. There appears to be multifocal initiation of disease rather than following the ascending or descending theory. Some variations were observed between men and women and in different age groups. This pattern of venous reflux is likely to be due to primary venous wall changes rather than primary valvular dysfunction.

Μελέτη Ποιότητας Ζωής Σε Ασθενείς Που Χειρουργούνται Για Υποτροπή Κιρσών Κάτω Άκρων

“…Ο Αναπτύχθηκε για να αξιολογήσει την εξέλιξη της CVD και επίσης να δώσει πρόσθετο βάρος σε σοβαρή κλινική νόσο (C4-C6)95,96 .Ο VCSS παρέχει μια ακριβέστερη μέτρηση για τη σοβαρότητα της νόσου και την επίδρασή της στις καθημερινές δραστηριότητες των ασθενών. Αν και χρησιμοποιείται ως βαθμολογία βαρύτητας, έχει επίσης βρεθεί ότι αποτελεί ένα χρήσιμο εργαλείο διαλογής εξαιτίας της συσχέτισής του με την απεικόνιση97,98 .2.2.2.2. Βαθμολογία της φλεβικής νόσου κατά τμήματα (Venous Segmental Disease Score-VSDS)Η βαθμολογία της φλεβικής νόσου κατά τμήματα (Venous Segmental Disease Score-VSDS) λαμβάνει υπόψη τους ανατομικούς και παθοφυσιολογικούς μηχανισμούς που εμπλέκονται στην εκδήλωση του CVD 95, (Πίνακας 3) .Πίνακας 3: Βαθμολογία της φλεβικής νόσου κατά τμήματα (Venous Segmental Disease Score-VSDS)Η βαθμολογία VSDS μετρά την ανατομική θέση και τη φύση (παλινδρόμηση ή απόφραξη) της φλεβικής νόσου, παρέχοντας αξιολόγηση της σοβαρότητας της παθοφυσιολογικής νόσου.…”