Diagnosis Of Color Doppler Ultrasonography In Lower Extremity Perforating Venous Insufficiency

Objective: 1 To summarize ultrasonographic character- istics of the perforating veins (PVs) in chronic venous insufficiency(CVI) of the lower extremity and investigate the relationship between them and the clinical stages in patients with lower extremity venous insufficiency.2 To estimate the clinical significance of diagnosis on lower extremity perforating venous insufficiency by color Doppler ultrasound.Methods: 50 patients(72 lower limbs) with chronic venous insufficiency of lower limbs who were collected randomly from the vascular surgery of the Second Hospital of HeBei Medical University from January 2007 to January 2008 examined by color Doppler ultrasound and lower extremity ascending phlebography. The clinical manifestations of chronic venous insufficiency (CVI) in the lower extremities were recorded in detail including vein varicosis, engorgement, hyperpigmentation, ulcer and et al, which were classified in class by the standard of CEAP classification (the clinical, etiologic, anatomic and pathophysiologic classification) system. All the patients were inspected by ultrasonograph. PHILIPS HDI-5000 in different position according to requect of examination, such as supine, prone and standing position. Valsalva method was employed in evoking reflux in femoral veins and great saphenous vein; Release of manual distal leg compression was employed in popliteal vein, posterior tibial veins, small saphenous vein and perforating veins. Firstly, above-mentioned veins were inspected to be confirmed no thrombosis in their lumens, then their valves function and degree of reflux were detected with the use of Valsalva and compression method; Secondly, the calf incompetent perforating veins (IPVs) were detected on release of manual distal leg compression, and their number and location were recorded; Thirdly, the diameters and velocities of the medial calf incompetent perforating veins were measured exactly; Eventually, the results were compared with those of lower extremity ascending phlebography, which was gold standard, then the accuracy of color Doppler ultrasound was assessed. And also, the relationship between the numbers, diameters and velocities of incompetent perforating veins and the clinical class of chronic venous insufficiency was evaluated. All statistical tests were performed with the use of SPSS software (version 13.0). Initially the homogeneity of variance among all the groups was analyzed. All the measurement data were expressed as mean±standard deviation (mean±SD) and Chi-square test and nonparametric correlation (rank correlation) was used to explore statistical significance. For these analyses, P<0.05 was considered statistically significant.Results: 1 In 50 patients(72 lower limbs),60 calves were detected to have incompetent perforating veins by color Doppler ultrasound and 63 calves to have incompetent perforating veins by lower extremity ascending phlebography. Lower extremity ascending phlebography was considered as the gold standard. The sensitivity, specialty and accuracy of color Doppler ultrasound reached 92.1%, 77.8%, 90.3%, respectively in diagnosis of lower extremity perforating venous Insufficiency. There were no significant differences statistically between the two methods (P>0.05).2 58 in 72 lower limbs were detected to have incompetent perforating veins homeochronously by color Doppler ultrasound and lower extremity ascending phlebography.225 incompetent perforating veins were identified in 58 limbs by color Doppler ultrasound, and 174 incompetent perforating veins (77.3%) were located in the medial calf, another 51 incompetent perforating veins (22.7%) in the anterolateral of the calf; 248 incompetent perforating veins were found in 58 limbs by lower extremity ascending phlebography, and 191 incompetent perforating veins (77.0%) were located in the medial calf, another 57 incompetent perforating veins (23.0%) in the anterolateral of the calf. Compared with the results in ascending phlebography, the match rate of color Doppler ultrasound for diagnosis of dilated or insufficient perforating veins was 90.7%.3 Nonparametric correlation (rank correlation) was applied to analyze the relationships between"the numbers, diameters and blood flow velocities"of the medial calf incompetent perforating veins and the"clinical stages". There were positive relationships between them with the correlation coefficient of 0.49, 0.61 and 0.52, respectively (P<0.05). There was statistical significance.Conclusion: 1 The skin changes of chronic venous insufficiency in the lower extremities are mainly relevant to the prevelence of the incompetent perforating veins in the lower medial calf. The treatment of the incompetent perforating veins in the medial calf may be important to improve the clinical manifestations, especially skin changes.2 Color Doppler ultrasound is helpful for the diagnosis and location of lower extremity insufficiency perforating veins and can provide a reliable base for clinical diagnosis and operation.3 Higher clinical stages were accompanied with great number, wider diameter or faster blood flow of incompetent perforating veins.