JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

Table of Contents

2018 Month : November Volume : 5 Issue : 49 Page : 3358-3362

ROLE OF COLOUR FLOW DUPLEX SONOGRAPHY IN EVALUATION OF VARICOSE VEINS OF LOWER LIMBS

Rama Krishna Narra1, Sushma Vuyyuru2, Bhimeswara Rao P3, Anusha Putcha4

1. Additional Professor, Department of Radio-diagnosis, Katuri Medical College, Guntur, Andhra Pradesh.
2. Resident, Department of Radio-diagnosis, Katuri Medical College, Guntur, Andhra Pradesh.
3. Professor, Department of Radio-diagnosis, Katuri Medical College, Guntur, Andhra Pradesh.
4. Junior Resident, Department of Radio-diagnosis, Katuri Medical College, Guntur, Andhra Pradesh.

Corresponding Author:
Dr. Sushma Vuyyuru,
Resident, Department of Radio-diagnosis,
Katuri Medical College, Guntur,
Andhra Pradesh.
E-mail: narra.ramki29@gmail.com
DOI: 10.18410/jebmh/2018/684

ABSTRACT
BACKGROUND
Varicose veins are dilated, tortuous veins mainly involving the superficial veins of lower limb. Depending on the presence or absence of the underlying cause, they are classified as primary and secondary.Colour Doppler / duplex scanning is a widely available non-invasive modality used for the evaluation of varicose veins. In this study, we evaluated the role of Doppler ultrasound for the evaluation of varicose veins and determine the cause where ever feasible.

MATERIALS AND METHODS
The study is a prospective study of 50 patients referred with signs and symptoms of varicose veins to the department of Radiodiagnosis at Katuri Medical College, Chinakondrupadu, between January 2016 and October 2017, for a period of 21 months.

RESULTS
A total of 42 (50%) cases were studied with colour duplex doppler of which 21 (42.86%) cases were primary, and 18 secondary to DVT and 3 (7.14%) congenital.

CONCLUSION
Colour duplex assessment of peripheral veins provides an adequate and rich information, both the anatomical and physiological information. Doppler imaging is non-invasive, radiation free, hassle free modality for examining the venous system, particularly with respect to the diagnosis of thrombus and chronic venous insufficiency particularly in symptomatic patients.

KEYWORDS
Colour Duplex Doppler, Lower Limb, Varicose Veins, DVT, Chronic Venous Insufficiency.

How to cite this article

Narra RK, Vuyyuru S, Bhimeswara Rao P, et al. Role of colour flow duplex sonography in evaluation of varicose veins of lower limbs. J. Evid. Based Med. Healthc. 2018; 5(49), 3358-3362. DOI: 10.18410/jebmh/2018/684

BACKGROUND

Varicose vein is a term usually described for dilatation of the superficial saphenous veins because of reflux in veins due to absent or dysfunction of the valves, which occurs generally in lower limbs because of their dependant position.1 Varicose veins are dilated, swollen, tortuous twisted veins on the skin especially the calf region.2 By definition a vein is varicosed if it is dilated tortuous and lengthened. In majority of the cases (upto 70%) the cause is not known and are Primary. Secondary varicose veins are due thrombus which may be superficial or deep in location.

Duplex doppler not only helps in determining the cause but opens a window for real time evaluation of the function of the valves which are key in the aetiopathogenesis of varicose veins. Prior to the advert of ultrasound and colour doppler clinical examination and invasive venography or varicography were main stay in the evaluation of patients with varicose veins.

Ultrasound and colour duplex provide a safe, non-invasive, radiation free, widely available modality in the evaluation of patients with varicose veins. Ultrasound also helps in guiding the interventional treatment including the sclerotherapy and laser ablation which are less invasive compared to surgical treatment.

Aims and Objectives

  1. To evaluate the range of different imaging findings on colour duplex ultrasound in patients who are referred with signs & symptoms of varicose veins and chronic venous insufficiency.
  2. To identify the patients of DVT with deep venous reflux as a cause of varicose veins.
  3. To describe the anatomical variants of venous anatomy and perforators of lower limbs in patients with varicose veins.

 

MATERIALS AND METHODS

  • Prospective study of 50 patients referred with signs and symptoms of varicose veins to the department of Radiodiagnosis at Katuri Medical College, Chinakondrupadu between January 2016 and October 2017, for a period of 21 months.

 

The study has been done using Philips Envisor CHD machine and GE Logiq machine.

Frequency probes used – 5MHz and 3.5MHz.

 

Inclusion Criteria

Cases of varicose veins referred for colour doppler sonography.

 

Exclusion Criteria

  1. Pregnant ladies.
  2. Severe obesity.
  3. Any chronic severe disease.

 

RESULTS

A study of 50 patients with signs and symptoms of varicose veins in the lower extremities was done. The following observations were made.

 

Sex

Cases Suspected with Varicose Veins

 

Number (%)

Male

38 (76%)

Female

12 (24%)

Total

50 (100%)

Table 1. Sex Distribution

 

Male predominance was found in our study. Of the 50 patients 38 (76%) were males and 12 (24%) were females.

 

Age Group in Years

Cases with Suspected Varicose Veins

 

Number (%)

11- 20

2 (4%)

21-30

6 (12%)

31-40

11 (22%)

41-50

15 (30%)

51-60

9 (18%)

61-70

7 (14%)

Total

50 (100%)

Table 2. Age Distribution

 

Age of the patients ranged from 19 to 68 yrs. 62% of the patients were older than 40 years.

 

Symptoms

Cases Suspected with Venous Insufficiency (%)

Swelling

16 (32%)

Varicosity

12 (24%)

Pain

8 (16%)

Ulcer

7 (14%)

Varicosity and Swelling

3 (6%)

Varicosity and Pain

2 (2%)

Eczema

2 (2%)

Total

50 (100%)

Table 3. Distribution of Cases by Symptoms

 

We found that swelling (32%) was the most common presenting symptom, followed by varicosity (24%) as the second most common presenting symptom.

 

 

No. of Cases (%)

Positive Doppler

42 (84%)

Normal Doppler

08 (16%)

Table 4: Doppler Ultrasound Findings

 

Of the total 50 cases, positive Doppler was noted in 42 cases. 8 cases showed normal Doppler study.

 

 

No. of Cases (%)

Unilateral

38 (90.48%)

Bilateral

4 (9.52%)

Total

42 (100%)

Table 5. Type of Involvement in Study Population with Evidence of Varicose Veins

 

Our study showed unilateral predominance (90.48%).

 

Extremities

Number of Cases (%)

Unilateral

Right

Left

 

12 (28.58%)

26 (61.90%)

Bilateral

4 (9.52%)

Table 6. Side of Involvement of

 the Veins in Patients with Varicosity

 

Left lower extremity predominance is noted in our study (61.90%) and bilateral involvement in 4 cases.

 

Factors

 

Cases with DVT

n= 18

Cases with Other Causes of Varicosities n= 24

 

Number (%)

Number (%)

Prolonged Hospitalization

5 (27.8%)

-

Trauma

3 (16.7%)

3 (12.5%)

Surgery

2 (11%)

-

Occupational

1 (5%)

8 (33.33%)

Hereditary

-

5 (20.8%)

No Known Predisposing Factor

8 (44.44%)

8 (33.33%)

Table 7. Predisposing Factors

 

Thus, prolonged hospitalization 5 (27.8%) and trauma 3 (16.7%) were the most common factors in patients with DVT. Occupational/ prolonged standing were common in 8 (33.33%) and hereditary factors 5 (20.8%) in other causes of varicosities.


 

CFV

SFV

PV

ATV

EIV

CIV

SVS

No. of cases showing involvement

11

13

8

4

4

1

7

Percentage of cases showing involvement

61.11

72.22

44.44

22.22

22.22

5.56

38.89

Table 8. Distribution of the Veins in Patients with Thrombi

 

 


Causes

Number (%)

Primary

21 (50%)

Secondary to DVT

18 (42.86%)

Congenital

3 (7.14%)

Total

42 (100%)

Table 9. Aetiological Classification of Varicosity in Patients Showing Reflux (with Doppler Study)

 

In our study primary varicosities predominated - 21 cases (50%). Varicosities secondary to DVT were seen in 18 cases (42.86%), congenital causes were rare and was noted in 3 cases (7.14%) of the total positive doppler study.

 

Segments

Bilateral Extremities

Unilateral Extremities

 

 

Right

Left

SFJ

1

6

11

SPJ

1

3

5

Perforator Incompetence

AK

1

1

0

BK

1

9

10

MC

2

4

14

AA

3

4

13

Table 10. Distribution of Incompetent Veins

 

(These include both primary and secondary varicosities)

 

GSV varicosity predominated in our study. SFJ incompetence was commonly noted in our study (18 cases). SPJ incompetence was noted in 9 cases. Perforator incompetence was seen in 31 cases, with below knee, mid-calf and above ankle perforators showing equal incidence (20 each).

 

Figure 1. Grey Scale and Colour Doppler Images showing Normal SFJ

Figure 2. Colour Doppler Image showing Normal SFA, SFV, Profunda Femoris Vein

Figure 3. Colour Doppler Image showing Varicosities along GSV

Figure 4. Colour Doppler Image Showing Perforator

Figure 5. (i) Transverse Scale Image Showing Thrombus in SSV. (ii) Sagittal Grey Scale Image showing Thrombus in CFV

Figure 6. Axial Grey Scale and Colour Doppler Images showing Thrombus in CFV