Systematization of localization and extension of pathological venous refluxes in great saphenous vein at primary varicose veins of the lower limbs
DOI:
https://doi.org/10.11603/2414-4533.2020.2.10771Keywords:
varicose veins disease of the lower limbs, great saphenous vein, vertical refluxes, classificationAbstract
The aim of the work: to improve the results of treatment of patients with primary varicose veins of the lower limbs by systematizing all types of localization and extention of pathological refluxes in the trunk of a great saphenous vein (GSV) for choosing differentiated surgical tactics.
Materials and Methods. The study included 560 patients with primary varicose veins of the lower limbs with pathological refluxes in different segments of GSV. All patients underwent ultrasound triplex scan of the venous system of the lower limbs.
Results and Discussion. All the possible types of localization and extention of pathological refluxes in the GSV trunk are classified into: 1) simple: "total" (incompetence of the terminal valve of the GSV with reflux along all the trunk up to the malleoli level), "proximal" (incompetence of the terminal valve of the GSV with reflux in the trunk to a certain level, but not to the malleoli), "segmental" (reflux in any segment of the GSV without involvement the proximal and distal parts of the vein, that is without terminal valve incompetence and without spreading to the malleoli level) and "distal" (reflux from a certain level of the GSV trunk, but not from the terminal valve, to the malleoli level); 2) complex: "proximal-segmental", "proximal-distal", "segmental-distal" and "proximal-segmental-distal" (combinations of corresponding simple refluxes). All these types of refluxes were observed with the following frequencies: 33.6 %, 1.3 %, 4.8 %, 35.9 %, 4.1 %, 19.1 %, 0.0 % and 1.2 %, respectively. A system of integration of the proposed classification into the international classification of chronic vein diseases CEAP has been developed. The advantages of the proposed classification are: 1) it has a clear practical orientation (for each of the reflux types different therapeutic tactics must be applied); 2) it takes into account all known nowadays types of the reflux spread; 3) it reflects the competence or incompetence of the terminal valve of the GSV; 4) it indicates the presence or absence of several separate segments of GSV with pathological refluxes; 5) it takes into account the spread or non-spread of reflux to malleoli level; 6) it is laconic; 7) it can be integrated into the international classification of chronic vein diseases CEAP.
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