Our Experience about Shared Venous Hemodynamics Map (SVHM): A Least Common Denominator for Computerized Comparison of the Results of Chronic Venous Disease (CVD) Treatment.

Abstract

Aim: Varicose veins, while frequently perceived as a cosmetic concern, should be evaluated within the broader context of chronic venous insufficiency (CVI) affecting the lower extremities. The Mappa Emodinamica Venosa Condivisa, Italian for Shared Venous Hemodynamics Map (MEVeC) project aims to provide an objective method for assessing the hemodynamic disorders underlying CVI and standardizing the evaluation of therapeutic interventions for lower extremity CVI. To achieve objective treatment assessment, it is essential to ensure uniform expertise among phlebologists and the ability to replicate comparable clinical outcomes.

Methods: The study focused on patients with internal saphenous vein varices due to saphenous-femoral junction incompetence. Cases exhibiting non-saphenous reflux or incontinence perforating veins were excluded from the study cohort. Experienced medical practitioners conducted ultrasound Doppler scans and interventions on patients meeting specific inclusion criteria. These criteria included age, varix status, lifestyle, and Clinical Etiology Anatomy Pathophysiology (CEAP) classification. The study involved 40 limbs of patients in two groups, one undergoing traditional surgery and the other ablative laser treatment, with a six-month follow-up.

Results: Group A (surgical intervention) exhibited a 5% incidence of ostial reflux and no saphenous vein reflux. In contrast, Group B (laser ablation) showed a 15% incidence of ostial reflux and a 20% incidence of saphenous vein reflux, with only one instance exceeding 0.5 seconds. The reflux observed in Group A was attributed to a previously undisclosed incontinent pudendal sub-ostial vein. In Group B, two instances of ostial refluxes resulted from a common incontinent confluence of the epigastric vein with other collateral vessels, while the third case presented sub-ostial incontinence.

Conclusions: Despite the absence of a standardized protocol for assessing the efficacy of diverse therapeutic interventions for Chronic Venous Disease (CVD), the MEVeC technique may offer a methodology to reproduce comparable clinical outcomes regardless of the treatment used. The primary objective of MEVeC is to quantitatively evaluate the hemodynamic disorders that are fundamental to the pathogenesis of chronic venous insufficiency, thereby facilitating standardized comparative analyses of outcomes across various Multidisciplinary Vascular Clinic (MVC) treatment strategies.