目的:确定大隐静脉(GSV)反流喂养的下肢静脉曲张网络的性别患病率,前副隐静脉(AASV)和小隐静脉(SSV)单独或组合。
方法:我们通过相同的彩色多普勒超声(CDS)协议扫描了1500名连续患者的3000条下肢,在2013-2023年十年期间受到有症状的慢性静脉功能不全(CVI)的影响。静脉功能正常的四肢,扫描不完整或受血栓后综合征影响,骨盆反流,静脉畸形,最终分析排除了静脉血栓水肿和CEAP临床C5-C6级.
结果:总体而言,1072名患者,252名(23.5%)男性和820名(76.5%)女性(p<0.0001),年龄匹配(p=0.692),共纳入1956年受原发性CVI影响的四肢研究,临床类别C2-C4。主要发现是仅通过AASV的反流(OR1.96,CI1.26-3.06,p=0.001)或与GSV联合使用(OR1.84,CI1.34-2.52,p=0.0002)喂养的静脉曲张网络在女性中的患病率很高。另一方面,仅GSV功能不全在男性中明显普遍存在(OR0.54,CI0.43-0.68,p<0.0001)。此外,我们考虑了在隐股骨交界处存在主管末端瓣膜(TV+),这导致女性更显著(OR1.57,CI1.12-2.19,p=0.0083);相反,无能的末端瓣膜(TV-)在男性中更常见(OR0.64,CI0.46-0.89,p=0.0083)。最后,考虑到AASV境内有电视+的回流,在女性中检测到强烈的患病率(OR2.28,CI1.48-3.52,p=0.0002),而当同时存在TV时,男性沿GSV出现反流(OR0.62,CI0.41-0.94,p=0.0244)。
结论:对下肢静脉曲张网络的分析突出表明,仅沿AASV的反流,在交界处有一个合格的终端阀门的情况下,或加上GSV不足,在女性中更为普遍。另一方面,GSV导致男性的主要躯干喂养静脉曲张,特别是当检测到一个不称职的终端阀门时。我们的发现表明,女性可能更容易发展为静脉曲张,具有上升机制,而在男性中,下降的人似乎更常见。
OBJECTIVE: To determine the sex prevalence of lower limb varicose networks fed by reflux of the great saphenous vein (GSV), anterior accessory saphenous vein (AASV), and small saphenous vein singularly or in combination.
METHODS: We scanned by the means of the same color Doppler ultrasound protocol 3000 lower limbs in 1500 consecutive patients, affected by symptomatic chronic venous insufficiency from 2013 to 2023. Limbs with normal venous function, incomplete scans, or that were affected by post-thrombotic syndrome, pelvic reflux, isolated perforator reflux, venous malformation, phlebolymphedema and Clinical, Etiological, Anatomical, Pathophysiological clinical class C5 and C6 were excluded from the final analysis.
RESULTS: Overall, 1072 patients-252 (23.5%) males and 820 (76.5%) females (P < .0001) matched for age (P = .692)-were included in the study for a total of 1956 limbs affected by primary chronic venous insufficiency, clinical class C2 to C4. The main finding was the significant prevalence of varicose networks fed by reflux of the AASV alone (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.26-3.06; P = .001) or combined with GSV (OR, 1.84; 95% CI, 1.34-2.52; P = .0002) in females. In contrast, GSV insufficiency alone was significantly prevalent in males (OR, 0.54; 95% CI, 0.43-0.68; P < .0001). No significant sex differences regarding SSV reflux were detected. Moreover, we considered the presence of competent terminal valve (TV+) at the level of the saphenofemoral junction, which resulted more significantly present in female (OR, 1.57; 95% CI, 1.12-2.19; P = .0083); to the contrary incompetent terminal valve (TV-) was more common in males (OR, 0.64; 95% CI, 0.46-0.89; P = .0083). Finally, considering reflux in the AASV territory in the presence of a TV+, a strong prevalence in females was detected (OR, 2.28; 95% CI, 1.48-3.52; P = .0002), whereas males developed reflux along the GSV when a concomitant TV- was present (OR, 0.62; 95% CI, 0.41-0.94; P = .0244).
CONCLUSIONS: The analysis of the lower limb varicose networks highlights that reflux along the AASV alone, in presence of a TV+ at the junction or coupled with GSV insufficiency, is more prevalent in females. In contrast, GSV resulted the main trunk feeding varicose veins in males, in particular when a TV- was detected. Our findings suggest that females could be more prone to developing varicose veins with an ascending mechanism, whereas in males the descending one seems to be more common.