Association between peripheral venous ultrasound parameters and clinical manifestations according to the CEAP classification in patients with varicose veins

BACKGROUND: To evaluate peripheral venous ultrasound parameters in association with clinical manifestations of chronic venous disease (CVD) according to the CEAP classification in patients with varicose veins (VV).METHODS: The study included 579 subjects with VV, CEAP classes C2 - C5/C6. The clinical class of CVD associated with VV was assessed using the CEAP classification. All patients underwent peripheral venous ultrasonography to evaluate venous anatomy; Valsalva and Siegel tests were performed to evaluate venous velocities and refluxes.RESULTS: Statistically significant differences in the diameter of the great saphenous vein (GSV) were obtained between CEAP classes C2 and C4, C2 and C5/6, C4 and C5/6 CEAP classes. Moreover, there were statistically significant differences in the diameter of the perforator veins (PV) between CEAP classes C2 and C3, C3 and C4, C4 and C5. Average velocities of the retrograde blood flow through the PV differed between CEAP classes C2 and C5/6. A statistically significant difference was present in both maximum and average blood flow velocity in Cockett III PV between CEAP classes C4 and C5.6 (P <0.05). Evaluation of deep venous blood velocities revealed venous reflux in 6.1% VV patients with ulcers. GSV diameter over 8.9±2.8 mm, PV diameter over 4.3±1.3 mm, maximum and average velocities of the retrograde blood flow through incompetent Cockett III PV over 66.1±28 cm / s and 52±19.7 cm / s were associated with the appearance of trophic ulcers (P <0.05).CONCLUSIONS: There is an association between peripheral venous ultrasound parameters and clinical manifestations of chronic venous disease in patients with varicose veins: larger GSV and perforator vein diameter as well as high velocity refluxes in Cockett III perforator veins were common in patients with venous ulcers. Interestingly, deep venous reflux was detected only in 6.1% VV patients with trophic ulcers due to CVD.