Abstract Objectives

Hemodynamic changes in C0 to C2 according to the CEAP2020 (clinical/etiological/anatomical/pathophysiological) classification have not been extensively analyzed. We intend to investigate the characteristics of early stage venous disease using VCSS (Venous Clinical Severity Score), HASTI (heaviness/ache/swelling/throbbing/itching) score and DUS (duplex ultrasound) derived parameters.

Methods

From Aug. 2020 to Jul. 2021, consecutive patients were categorized according to the CEAP 2020 classification. The vein diameter (mm), reflux time (s), cross section area (cm2), peak and mean reflux velocity (cm/s), total reflux volume (ml) were documented in the superficial system and deep system. VCSS and HASTI scores were assessed and DUS parameters were analyzed. P <.05 was considered statistically significant.

Results

257 consecutive patients (142 female) with 371 limbs were studied. The mean age was 50.96±13.27 years (range 20-81; median 53) with an average body mass index of 24.03±2.96 kg/m2 (range 17.00-33.06; median 23.67). The proportion of clinical (C) category was as followed: 47 C0S (12.67%); 45 C1 (12.13%); 279 C2 (75.20%). 42.6% of C0 and 62.2% of C1 were associated with some form of venous reflux, Pr [pathology (P)-reflux]. Reflux of GSVa (above knee great saphenous vein) was the most commonly affected vein segment from C0-2. C1 differed from C0 only by age and severity scores with a cut-off value of 1 for both VCSS and HASTI. Larger saphenous veins diameter (GSV and SSV) were seen in Pr [pathology (P)-reflux] than Pn [pathology (P)-none] of C0 cases. Larger deep vein diameters (CFV, FV, and POPV) were evident in Pr versus Pn of C1 cases. In C2, both popliteal vein (POPV), sapheno-femoral junction (SFJ) and GSVa were dilated in Pr cases.

Conclusions

Both HASTI and VCSS were discriminative from C0 to C2. C0 differed from C1 by age and severity scores as DUS characteristics were not significantly different between the 2 groups. Vessel diameter played a discriminative role in distinguishing Pn versus Pr cases in each C0-2 category. GSVa was the most frequent reflux segment irrespective of reflux types.

Article InfoPublication History

Accepted: May 25, 2022

Received in revised form: May 11, 2022

Received: February 7, 2022

Publication stageIn Press Journal Pre-ProofFootnotes

Meeting Name

This study was presented at the 35th American Vein and Lymphatic Society (AVLS) 2021 Annual Congress at Denver Colorado, October 8, 2021.

Article Highlights

Type of Research:

Single-center retrospective cohort study.

Key Findings:

We analyzed 257 consecutive patients. More than half of C0S and 1/3 of C1 were Pn[pathology (P)-none] cases. Reflux of GSVa (above knee great saphenous vein) was the most commonly affected vein segment in C0-2. C1 differed from C0 only by age and severity scores with a cut-off value of 1 for both VCSS and HASTI. Saphenous vein diameter was larger in C0Pr than C0Pn, while the same was true in deep vein diameter in C1.

Take home message:

This study analyzed the clinical description of C0 to C2 patients in China and determined the clinical and hemodynamic characteristic of early stage CVD.

Table of Contents Summary

Based on this retrospective cohort analysis of 257 patients, the ratio of Pr[pathology (P)-reflux] cases in C0S (C0 symptomatic) category was no less than in C1 (P=.059) in the Chinese patient population. The authors recommend VCSS score and vein diameter as references in distinguishing C0S and C1 patients.

Declaration of Conflict of Interest

The author(s) have no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

This project is not supported by any sources of funding up to now.

Introduction:

Identification

DOI: https://doi.org/10.1016/j.jvsv.2022.05.007

Copyright

© 2022 Published by Elsevier Inc. on behalf of the Society for Vascular Surgery.

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