Congrès SFP décembre 2014

Is saphenous vein diameter a relevant criterion?


Venenpraxis, Wunstorf

Great saphenous vein (GSV) incompetence is involved in the majority of cases of varicose disease.
Stratifi cation of venous disease severity is still diffi cult. Several studies have demonstrated correlation
between diameters and clinics. Lots of interventional studies measure diameters, but at so different
points, that a comparison is futile. After two differing studies were presented in 2014 a new series has
been done to highlighten the reasons for the contradictory results. The aim of the latest series

were to correlate GSV diameters with C of CEAP and the venous clinical severity score (VCSS).

Legs with untreated isolated GSV refl ux and varicose veins limited to the GSV territory and control legs
were studied clinically, with duplex ultrasound and photoplethysmography. The GSV diameters were
measured both next to the saphenofemoral junction (SFJ) and at proximal thigh (PT) and correlated to

The control legs-group 1 were n=33, 6 male, mean age 53, mean BMI 26.
The legs with refl ux-group 2 were n=78, 16 male, mean age 54, mean BMI 27.
With photoplethysmography the mean refi lling time in group 1 was 34.8 sec and in group 2 24 sec (p
< .001). The mean diameters for the SFJ (±SD) for groups 1 and 2 were 6.4±1.8 and 9.9±3.4. For PT
they were 3.6±0.9 and 5.9±1.8 respectively. In refl uxive legs the SFJ diameter correlates strongly with
the PT diameter (r=0.69) and moderately with the C of CEAP and VCSS; 0.42 and 0.45 respectively.
The PT diameter correlates slightly better with the C and VCSS than the SFJ diameter (0.55 and 0.57).
The mean values of VCSS for groups 1 and 2 of VCSS were 0.70 and 4.69. The C of CEAP and VCSS
show a strong correlation among them with r=0.79 in group 2 and 0.80 in the whole sample. Subgroup
analysis demonstrates, that in a group with only visible varicose veins (C2) the diameter correlates with
the VCSS, so that it might help in decision taking in this group of patients, where an intervention is not
as highly indicated.

The GSV diameters next to the SFJ and particularly at the PT in patients having refl ux correlate strongly
with both the C of CEAP and VCSS. As the diameter at the GSV is highly variable and recorded in very
different ways amongst the different groups, a standardisation is desireable for future investigations.
Regarding the higher correlation at PT with the Clinics and the less variability of diameters at this point
the measurement at PT is proposed as standard measurement point. Recording the GSV diameters at
the SFJ and in any case at the PT in a standardized way may improve comparison of data and contribute
to choice of treatment.

Key words: Vein diaemeters, venous clinics