does multiple axial vein incompetence increase the clinical severity of venous disease?

Division of Vascular and Endovascular Surgery

Lowell S. Kabnick, MD, FACS

Does Multiple Axial Vein Incompetence Increase The Clinical Severity Of Venous Disease?

Division of Vascular and Endovascular Surgery

Disclosure.

I do not have any potential conflict of interest

Patterns of saphenous reflux in women with primary veins 590 limbs(326 women) C2 class Reflux 80% GSV and SSV 17%

GSV 60% SSV 20%Nonsaphenous 20%

Englehorn; JVS 2005;41-645-51

Division of Vascular and Endovascular Surgery

LOWELL S. KABNICK, MD

HAMZA RANA, MD

Clinical Severity and Number of Superficial Axial Veins with Reflux in Each Lower Extremeity

Division of Vascular and Endovascular Surgery

Study Aim:

To evaluate the association between clinical severity of primary varicose veins and number of superficial axial veins with reflux for each leg

Division of Vascular and Endovascular Surgery

Study Design

•Single Center, Retrospective•Patients:

•>18 yr- seen at NYU Langone Medical Center Vein Center -November 2012 and February 2013 with baseline data available for CEAP clinical class, VCSS, and Venous DUS.

•Excluded were:•Patients <18 year of age•History of previous lower extremity superficial venous intervention

•Deep venous thrombosis.

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Predictor Variable: •Clinical classification of CEAP•Revised Venous Clinical Severity Score

Outcome Variable:•Number of axial superficial veins with reflux on venous duplex ultrasound

•Duration of reflux > 0.5 seconds•GSV, SSV, AASV, PASV saphenous vein, intersaphenous vein (Vein of Giacomini), and cranial extension of small saphenous vein

•Relevant Covariates:•Age, sex, BMI, number of pregnancies

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RESULTS

Patient CharacteristicsVariable Total

(SD,%)N=150

Males(SD,%)N=39

Females(SD,%)N=111

P Value

Age , Years ± SD 52.81±14.9 52.82±16.6 52.80±14.4 0.99

BMI, kg/m2 22.89±3.4 29.37±7.9 24. 56±5.7 <.005

Family Hx of Varicose Veins

103 (77.4%) 18 (54.5%) 85(85%) <.005

Mother 61(49.6%) 9(31%) 52(55.3%) <.005

Father 29(23.6%) 6(20.7%) 23(24.5%) 0.67

Grandparents 18(14.6%) 1(3.4%) 17(18.1%) 0.04

Hx of Superficial Phlebitis

11(7.3%) 4(10.3%) 7(6.3%) 0.31

Deep Vein Reflux 16(10.7%) 5 (12.8%) 11(9.9%) 0.40

VCSS,Median(range) 4(0-25) 5(0-25) 3(0-13) NS

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CEAP Clinical Categories

63% ≥ C-3

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Number of Superficial Axial Veins with Reflux

10.7%

83/150 ≥1 superficial Axial veins reflux (55.3%)

Superficial Vein with Reflux

Total (%)

Males(%)

Females(%)

P Value

GSV 72 (48%) 24 (61.5%) 48 (43.2%) 0.04

SSV 17 (11.3%) 4 (10.3%) 13 (11.7%) 0.53

AASV 8 (5.3%) 4 (10.3%) 4 (3.6%) 0.12

Giacomini 3 (2.6%) 0 (0%) 3(2.7%) 0.40

Cranial Extension of SSV

0 0 0 --

Posterior ASV 0 0 0 --

GSV+ SSV 10 (6.6%) 3(7.6%) 8(7.2%) NS

GSV + AASV 3 (2.0%) 3(7.6%) 0 --

GSV + Giacomini 1 (0.7%) 0 1(0.9%) --

SSV+ Giacomini 3 (2.0%) 0 3(2.7%) --

GSV+ SSV+ Giacomini

1 (0.7%) 0 1(0.9%) --

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CEAP Category & Superficial Refluxing Veins

Cochran-Armitage Trend Test for CEAP Categories <0.0001

There is a trend towards multiple superficial veins with worsening CEAP class with P value of <.0001

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Correlation Between Number Of Refluxing Superficial Axial Veins And Clinical Variables

Variable Number of Superficial Veins with Reflux r Value

P Value

VCSS 0.43 0.01

CEAP 0.56 0.01

Age -0.04 0.56

BMI 0.09 0.23

Pearson and Spearman Coefficient (r values) Correlation>0.5 strong0.3-0.5 moderate

Univariate Logistic Regression AnalysisVariable Multiple Superficial

Axial Veins (≥2) Odds Ratio

95% CI OR P Value

CEAP Category CEAP C 0-2 CEAP C 3-6

0.09 0.01 0.72 0.02

11.11VCSS 1.11 1.00 1.23 .06

Gender Female 0.54 0.18 1.61 0.27

Age 0.99 0.96 1.03 0.81

BMI 1.03 0.95 1.12 0.40

Multivariate Logistic Regression AnalysisVariable Multiple Superficial

Axial Veins(≥2) Odds Ratio

95% CI OR P Value

CEAP Category

CEAP C 0-2 CEAP C 3-6

0.10 0.01 0.88 0.03

10

VCSS 1.04 0.90 1.20 0.56

Female Vs Male 1.24 0.28 5.55 0.77

Pregnancy ≤2 Vs > 2 0.99 0.22 4.48 0.97

Age 0.99 0.95 1.03 0.79

BMI 1.01 0.92 1.13 0.72

No Interaction between Gender, CEAP or VCSS

C 3-6 is Independent predictor for multiple superficial veins

Conclusions Multiple superficial Axial veins with reflux in the

lower extremity are present in 11% of Patients

Advanced CEAP Clinical Class is an independent predictor for multiple superficial Axial Veins with reflux (Odds Ratio of 10 for Multiple Superficial Axial Vein)

Revised VCSS was not statistically significant independent predictor for multiple superficial Axial Veins with reflux.