Ultrasonographic hemodynamical and epidemiological factors in advancement of clinical manifestations in primary varicose veins.

BACKGROUND Primary varicose veins (PVV) represent the most prominent clinical manifestation of chronic venous disease (CVD) and has a complex pathophysiological background. Objective of our study was to investigate the impact of sonographic hemodynamical and contemporary epidemiological factors on the clinical severity of PVV. METHODS We analyzed the sonographic hemodynamical and clinical parameters from 159 consecutive CVD patients and 233 lower limbs with PVV of clinical stages C2, C3 and C4. Univariate and logistic regression analysis was performed between patients of C2 (n=70 - 30.0%) and C3 - 4 stages and between subgroups C3 (n=101 - 43.3%) and C4 (n=62 - 26.6%). RESULTS Reflux of common femoral vein and saphenofemoral junction was detected in 43.3% and 65.7%. High venous reflux rates were found at the great saphenous above and below knee (90.1% - 53.2%) and in Cockett perforators (80.5%). Logistic regression revealed that factors associated with the symptomatic C3 - 4 stages were the duration of disease >10 years (p=.015, insufficiency in two or more perforators (p<.001) and history of 2 pregnancies (p=.001). Analysis C3 vs C4 showed that insufficiency in two or more perforators increased the likelihood of advanced C4 clinical stage by 2.2 times, (p=.037). Additional significant factor was the presence of at least one incompetent Cockett perforator. CONCLUSIONS Clinical severity of PVV is correlated with a plethora of complex anatomical, hemodynamical and epidemiological factors. Insufficiency in two or more perforators seems to play the most important role and this highlights the value of preoperative venous ultrasound mapping.