目的:慢性静脉疾病患者可出现不同的潜在血流动力学异常,浅静脉和穿支静脉。这篇综述探讨了反流模式之间的关系,静脉反流程度及慢性静脉疾病的临床表现。
方法:系统检索了1946年至2024年4月1日的Medline和EMBASE数据库。在入围论文的参考文献中搜索相关文章。包括研究,如果他们是英语语言,包括≥16岁的参与者,记录的反流模式≥以下2种:深,表面和/或射孔系统,以及与演示或严重性相关的模式。排除标准包括孤立性深静脉血栓形成的患者,血栓形成后综合征或狭窄或阻塞性疾病。
结果:确定了18项研究(11,177名参与者,范围55到3016)。荟萃分析显示,C4-6疾病与深反流(OR2.41,95%置信区间(CI)1.53-3.78)和穿支反流(OR3.37,95%CI2.16-5.27)相关,但不是浅表反流(OR2.11,95%CI0.87-5.14),与C0-3病相比。严重的慢性静脉疾病(C4-6)与孤立的深,合并深/浅层和合并浅层/穿支反流。两项研究表明,CVD进展的最高风险(定义为静脉曲张从头发展和进展到更大的CVD严重程度)与深/浅表反流有关。
结论:虽然受限于研究的异质性,这篇综述证实了反流模式是临床分类的重要预测指标,较高的CEAP阶段与较高的浅表患病率相关,深和穿孔器回流。孤立的深层和合并的反流似乎也可以预测腿部溃疡的发作。未来的研究应该将反流模式与治疗结果联系起来,包括复发风险。这可以帮助为卫生政策和管理指南提供信息,以便反流模式,结合其他人口统计学和血液动力学参数,可用于对患者进行风险分层,并确定可能从早期治疗中受益的个体。
OBJECTIVE: Patients with chronic venous disease (CVD) can present with different underlying hemodynamic abnormalities affecting the deep, superficial, and perforator
veins. This review explores the relationship between reflux patterns, extent of venous reflux, and clinical manifestations of CVD.
METHODS: The Medline and EMBASE databases were searched systematically from 1946 to April 1, 2024. References of shortlisted papers were searched for relevant articles. Studies were included if they were in English language, included participants ≥16 years of age, documented reflux patterns in two or more of the following: deep, superficial, and/or perforator systems, and related patterns to presentation or severity. Exclusion criteria included patients with isolated deep venous thrombosis, post-thrombotic syndrome or stenotic or obstructive disease.
RESULTS: We identified 18 studies (11,177 participants; range, 55-3016). Meta-analysis showed significant odds ratios (OR) for C4-6 disease being associated with deep reflux (OR, 2.41; 95% confidence interval [CI], 1.53-3.78) and perforator reflux (OR, 3.37; 95% CI, 2.16-5.27), but not superficial reflux (OR, 2.11; 95% CI, 0.87-5.14), vs C0-3 disease. Severe CVD (C4-6) was significantly associated with isolated deep, combined deep and superficial, and combined superficial and perforator reflux. The greatest risk of CVD progression (defined as de novo development of varicose
veins and progression to greater CVD severity) was shown by two studies to be related to combined deep and superficial reflux.
CONCLUSIONS: Although limited by the heterogenous nature of the studies, this review confirms that reflux pattern is a significant predictor of clinical class, and higher clinical, etiological, anatomical, and pathophysiological stages are associated with a higher prevalence of superficial, deep, and perforator reflux. Isolated deep and combined reflux also seem to be to predict the onset of leg ulceration. Future studies should relate reflux patterns to treatment outcomes, including recurrence risk. This work could help to inform health policies and management guidelines so that reflux patterns, in conjunction with other demographic and hemodynamic parameters, could be used to risk stratify patients and identify individuals who may benefit from earlier treatment.