Clinical Significance of Anterograde Angiography for Preoperative Evaluation in Patients with Varicose Veins
Article Sidebar
Main Article Content
Abstract
Objective: To investigate the clinical significance of preoperative lower extremity venography in patients with varicose veins.
Methods: From February 2019 to July 2023, 498 patients (583 diseased lower limbs) with lower limb varicose veins as the first symptom were selected and admitted to the Seventh People’s Hospital of Chongqing. Paracentesis of the deep veins of the lower extremities was performed in all affected limbs to observe the morphology of the deep veins from the ankle to the pelvis, the patency of the deep veins, and the reflux of contrast medium when the patients performed the Valsalva manoeuvre. The aetiology of varicose veins was analysed according to the imaging manifestations and individualised treatment plans were formulated according to the different aetiologies.
Results: The imaging success rate of 583 diseased lower limbs was 100%, of which 285 (48.9%) were primary lower limb deep vein valve insufficiency, 186 (32%) were simple superficial varicose veins, 63 (10. 8%) were iliac vein compression syndromes, 41 (5%) were post-thrombotic syndromes of the deep veins of the lower limbs and the others (primary deep vein avascularity of the lower limbs, bifemoral venous malformations, congenital varicose vein osteohypertrophy syndrome, tumour compression, etc.) 8 articles (1.37%).
Conclusion: The advantages of lower extremity deep vein bypass angiography are simple operation, low trauma, and high specificity, which can help to diagnose the aetiology of lower extremity varicose veins and guide the clinical treatment.
Article Details
Copyright (c) 2025 Liu Y, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Mei Y, Zheng Y. Anatomy and research progress of color Doppler ultrasound in the superficial varicosis of lower limbs. Chinese Journal of Clinicians (Electronic Edition). 2015;21:4001-4005.
Kouri B. Current evaluation and treatment of lower extremity varicose veins. The American Journal of Medicine. 2009;122(6):513-515. Available from: https://doi.org/10.1016/j.amjmed.2009.01.019
LVW, Wu XJ, Collins M, Han ZL, Jin X. Analysis of a series of patients with varicose vein recurrence. The Journal of International Medical Research. 2012;40(3):1156-1165. Available from: https://doi.org/10.1177/147323001204000336
Guidelines for the diagnosis and treatment of chronic venous diseases in China.
Shen K, Zhu F, Cheng C, Yu H. Exploring the causal relationship between plasma lipids and varicose veins of lower extremity: A comprehensive two-sample Mendelian randomization study. Medicine (Baltimore). 2024;103(36):e39514. Available from: https://doi.org/10.1097/md.0000000000039514
Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H, et al. The 2020 update of the CEAP classification system and reporting standards. Journal of Vascular Surgery. Venous and Lymphatic Disorders. 2020;8(3):342-352. Available from: https://doi.org/10.1016/j.jvsv.2019.12.075
Kumar A, Ranjan N, Mudgal SK, Patidar V. Clinical profile of leg symptoms and reflux in the legs from varicose veins disease reported at a tertiary healthcare institute in Jharkhand, India. Cureus. 2024 Sep 10;16(9):e69138. Available from: https://doi.org/10.7759/cureus.69138
Raffetto JD, Khalil RA. Mechanisms of varicose vein formation: valve dysfunction and wall dilation. Phlebology. 2008;23(2):85-98. Available from: https://doi.org/10.1258/phleb.2007.007027
Yu ZJ, Zhou W. Differential diagnosis and treatment of varicose veins in the lower limbs. Journal of Vascular and Luminal Vascular Surgery. 2016;2(1):71-76:81.
Liu CJ. Diagnostic technique and evaluation of lower extremity venous diseases in lower extremity venous surgery. Chinese Journal of Practical Surgery. 2001;(5):5-7.
Wu HD, Gao Y. Value of deep venography examination in the analysis of lower extremity varicose veins etiology. West China Medicine. 2014;29(11):2088-2091.
Huang XT. Surgical indications and technique for sequelae of lower extremity DVT. Chinese Journal of Practical Surgery. 2018;38(12):1440-1442.
Wei RZ, Zhang XC. Etiology and imaging progression of iliac vein compression syndrome. China Medical Imaging Technology. 2019;35(1):152-155.
Diagnostic techniques and evaluation of lower limb venous diseases in lower limb venous surgery.
Lawrence PF, Hager ES, Harlander-Locke MP, Pace N, Jayaraj A, Yohann A, et al. Treatment of superficial and perforator reflux and deep venous stenosis improves healing of chronic venous leg ulcers. J Vasc Surg Venous Lymphat Disord. 2020;8(4):601-609. Available from: https://doi.org/10.1016/j.jvsv.2019.09.016
Kheirelseid EAH, Crowe G, Sehgal R, Liakopoulos D, Bela H, Mulkern E, et al. Systematic review and meta-analysis of randomized controlled trials evaluating long-term outcomes of endovenous management of lower extremity varicose veins. J Vasc Surg Venous Lymphat Disord. 2018;6(2):256-270. Available from: https://doi.org/10.1016/j.jvsv.2017.10.012
Raffetto JD. Pathophysiology of Chronic Venous Disease and Venous Ulcers. Surg Clin North Am. 2018;98(2):337-347. Available from: https://doi.org/10.1016/j.suc.2017.11.002
Gong B, Chen D, Chen Z, Shan C, Zhang C, Gu Y. Clinical significance of antegrade lower limb venography in varicose veins of lower limbs. Chinese Journal of Physicians. 2019. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/wpr-800551
Nicolaides AN, Labropoulos N. Burden and Suffering in Chronic Venous Disease. Adv Ther. 2019 Mar;36(Suppl 1):1-4. Available from: https://doi.org/10.1007/s12325-019-0882-6
Lurie F. Advanced Stages of Chronic Venous Disease: Evolution of Surgical Techniques and Advantages of Associated Medical Treatment. Adv Ther. 2020;37(Suppl 1):6-12. Available from: https://doi.org/10.1007/s12325-019-01216-w
Gloviczki P, Lawrence PF, Wasan SM, Meissner MH, Almeida J, Brown KR, et al. The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II: Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine. J Vasc Surg Venous Lymphat Disord. 2024;12(1):101670. Erratum in: J Vasc Surg Venous Lymphat Disord. 2024;12(5):101923. Available from: https://doi.org/10.1016/j.jvsv.2023.08.011
Kolosovych IV, Korolova KO, Teplyi VV, Korolova ZV, Sydorenko RA. The importance of the prognostic score for the choice of CHIVA hemodynamic surgery as a treatment method for varicose veins of the lower extremities. Wiad Lek. 2023;76(7):1562-1568. Available from: https://doi.org/10.36740/wlek202307108
Wang X, Zhang B, Jiang Y. The value of antegrade angiography in the etiology of lower extremity varicose veins. Chinese Journal of General Surgery. 2020;29(6):686-692.
Tian Z, Jiang M, Zhang B. Evaluation of the clinical application of deep venography of the lower limbs (7908 affected limb angiography data analysis). Progress of Modern General Surgery in China. 2001;(1):51-53.
Zhang J, Zhao T. Clinical significance of antegrade deep venography of lower limbs for preoperative examination of patients with varices. Journal of Vascular and Luminal Vascular Surgery. 2020;6(3):279-281.
Wang M, Venus, Zhen Y. Treatment of primary deep venous valve insufficiency of the lower limbs. Chinese Journal of General Surgery. 2008;(6):611-613.
Song XJ, Liu ZL, Zeng R, Zheng YH, Ye W. Clinical efficacy of percutaneous minimally invasive radiofrequency therapy in patients with varicose veins with deep venous valve insufficiency. Vascular and Endovascular Surgery. 2020.
Guo Y, Chen H, Cai H. Analysis of missed cases of non-thrombotic iliac vein compression syndrome and evaluation of the lumen treatment effect. Chinese Journal of General Surgery. 2016;25(6):882-886.
Jiao Y, Zhang X. Surgical intervention mode and thinking after deep vein thrombosis of lower extremities. Chinese Journal of Practical Surgery. 2015;35(12):1291-1294.
Rabe E, Partsch H, Hafner J, Lattimer C, Mosti G, Neumann M, et al. Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement. Phlebology. 2018;33(3):163-184. Available from: https://doi.org/10.1177/0268355516689631
Lurie F, Schwartz M. Patient-centered outcomes of a dual action pneumatic compression device in comparison to compression stockings for patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord. 2017;5(5):699-706.e1. Available from: https://doi.org/10.1016/j.jvsv.2017.06.003
Kakkos SK, Guex JJ, Lugli M, Nicolaides AN. CEAP clinical classes C0S-C4: differences, similarities and role of Ruscus + HMC + vitamin C in patients with chronic venous disease. Int Angiol. 2020;39(2):118-124. Available from: https://doi.org/10.23736/s0392-9590.20.04341-2
Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342-352. Epub 2020 Feb 27. Erratum in: J Vasc Surg Venous Lymphat Disord. 2021;9(1):288. Available from: https://doi.org/10.1016/j.jvsv.2019.12.075
Han D, Shen C, Zhou Y. Lower extremity venous imaging study progress in the preoperative evaluation of venous insufficiency. Journal of Vascular and Luminal Vascular Surgery. 2017;3(2):685-689.
O'Donnell TF, Balk EM, Dermody M, Tangney E, Iafrati MD. Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. J Vasc Surg Venous Lymphat Disord. 2016;4(1):97-105. Available from: https://doi.org/10.1016/j.jvsv.2014.11.004
Nesbitt C, Bedenis R, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database Syst Rev. 2014;(7):CD005624. Update in: Cochrane Database Syst Rev. 2021;8:CD005624. Available from: https://doi.org/10.1002/14651858.cd005624.pub3
Cina G, Narese D, Amicucci V, Filipponi M, Snider F. Recurrent varicose veins of the legs: a single centre experience. Clin Ter. 2014;165(4):183-186. Available from: https://doi.org/10.7417/ct.2014.1730
Herman J, Musil D, Tichy M, Bachleda P. Recurrent varicose veins: causes and neovascularisation. A 17-year experience. Int Angiol. 2015;34(1):53-59. Epub 2014 Oct 7. Available from: https://pubmed.ncbi.nlm.nih.gov/25291408