目的:探讨通过彩色多普勒超声检查在坐姿下使用踝泵方法评估小腿穿通静脉的可行性和有效性。
方法:我们在2022年11月至2023年10月之间进行了一项多中心前瞻性临床试验。纳入符合条件的慢性静脉疾病患者和健康对照。通过三种不同的方法评估小腿穿通静脉,即在站立位置手动压缩,坐姿手动压缩,脚踝泵处于坐姿。比较3种方法对无功能穿支静脉的反流持续时间和检出率。分析小腿穿支静脉的数量和直径以及无能穿支静脉的分布。
结果:共纳入50例慢性静脉疾病患者和50例健康对照。有173头小牛被分析,包括97只健康的小牛和76只患有慢性静脉疾病的小牛。患病小牛(7.0,四分位数6.0-8.0)的每头小牛的穿孔静脉中位数高于健康小牛(5.0,3.0-6.0)(p<0.001)。无能穿通静脉的直径(2.3,2.0-3.1mm)大于有能力的穿通静脉的直径(1.4,1.2-1.7mm)。大多数无能的穿通静脉(78.8%)位于小腿的内侧和后中部。踝泵方法引起的回流持续时间大于手动加压方法引起的回流持续时间(p<0.001)。尽管踝泵方法对无能穿通静脉的检出率(92.0%)高于手动加压方法(站立和坐姿为71.7%和74.3%,分别)(p<0.001),尤其是在小腿远端,手动压缩方法显示了踝泵方法未显示的无能穿通静脉。
结论:患有慢性静脉疾病的小牛比健康小牛有更多的穿通静脉。不称职的小腿穿通静脉通常大于称职的穿通静脉,大部分不称职的小腿穿通静脉位于小腿的内侧和后中间。最重要的是,AP-sit方法为评估小腿穿通静脉提供了一种方便有效的方法,尤其是那些位于小腿远端的,作为传统手动压缩的替代或补充,这在超声医师的日常实践中很有价值。
OBJECTIVE: We investigated the feasibility and efficacy of assessing calf perforating
veins (PVs) using the ankle pump in a sitting position (AP-sit) method by color Doppler ultrasound.
METHODS: We performed a multicenter prospective clinical trial between November 2022 and October 2023. Eligible patients with chronic venous disease and healthy controls were enrolled. The calf PVs were assessed using three different methods: manual compression in a standing position, manual compression in a sitting position, and AP-sit method. The reflux durations and detection rate of incompetent PVs (IPVs) were compared among the three methods. The number and diameter of calf PVs and distribution of IPVs were analyzed.
RESULTS: A total of 50 patients with chronic venous disease and 50 healthy controls were included. There were 173 calves analyzed, including 97 healthy calves and 76 calves with chronic venous disease. The number of PVs per calf was higher in the diseased calves (median, 7.0; interquartile range [IQR], 6.0-8.0) than in the healthy calves (median, 5.0; IQR, 3.0-6.0; P < .001). The diameter of IPVs (median, 2.3 mm; IQR, 2.0-3.1 mm) was larger than that of competent PVs (median, 1.4 mm; IQR, 1.2-1.7 mm). Most of the IPVs (78.8%) were located in the medial and posterior middle of the calf. The reflux duration induced by the AP-sit method was greater than that induced by the manual compression methods (P < .001). Although the AP-sit method had a higher detection rate (92.0%) of IPVs than the manual compression methods (71.7% and 74.3% for standing and sitting, respectively; P < .001), especially in the distal lower leg, the manual compression methods found IPVs not found using the AP-sit method.
CONCLUSIONS: Diseased calves with chronic venous disease have more PVs than do healthy calves. IPVs are commonly larger than competent PVs, with most IPVs located in the medial and posterior middle of the calf. Most importantly, the AP-sit method provides a convenient and effective approach for assessing the calf PVs, especially those located in the distal calf, as an alternative or complementary method to traditional manual compression, which is valuable in the daily practice of sonographers.