Clinical symptoms and signs and severity of venous disease are not associated with non-thrombotic iliac vein lesions in patients with primary varicose veins

Abstract

Introduction and purpose. The purpose of this study was to determine relationship between non-thrombotic iliac vein lesions and symptomatology of primary varicose veins (PVV). The identification of such association would be helpful in selecting patients with PVV for further diagnostic evaluation. Material and methods. Thirty-two patients with unilateral PVV scheduled for great saphenous vein high ligation and stripping were enrolled in the study. There were 25 (78%) women. The mean age of the patients was 48 years. The patients were asked about pain, oedema, night cramps, heaviness and a history of superficial thrombophlebitis in PVV limb. A clinical stage of CEAP classification was determined and Venous Clinical Severity Score (VCSS) was calculated. During the surgery right and left iliac venous axes were interrogated with an intravascular ultrasound with Volcano s5 Imaging System (Volcano Corporation, Rancho Cordova, CA, USA) and catheters Visions PV .035 minimal lumen area (MLA) and percentage of stenosis (%S) of examined veins were calculated. An association between clinical symptoms and signs in PVV limb and %S of ipsilateral common iliac vein (CIV) and external iliac vein (EIV) was statistically analysed. Results. Pain, oedema, night cramps, heaviness and history of superficial thrombophlebitis were reported by 14 (44%), 17 (53%), 11 (34%), 19 (59%) and 6 (19%) of patients respectively. Twenty-five (78%) limbs were classified as C2 and 7 (22%) limbs as C4a according to CEAP classification. The median VCSS was 4. The mean MLA and %S was 92,9 mm2 and 47% and 74,2 mm2 and 48% for CIV and EIV respectively. Neither smaller MLA nor greater %S of CIV and EIV were associated with symptoms, more advanced stage of CEAP classification or higher VCSS. Conclusions. Neither clinical symptoms nor severity of venous disease can identify non-thrombotic iliac vein lesions in patients with primary varicose veins.