Ultrasound changes of the varicose veins of the lower extremities against connective tissue dysplasia
Keywords:ultrasound angiography, varicose disease, undifferentiated connective tissue dysplasia
AbstractBackground. The article presents the data of sonographic study of patients with varicose veins of the lower extremities in order to determine the typical ultrasound manifestations of connective tissue dysplasia. Revealed changes in these patients indicate a widespread and combined lesion of the lower extremity venous system almost on all the levels, which explains the pathogenic role of connective tissue weakness of veins framework and has a great diagnostic value in the planning stages of surgical treatment and selecting the volume of full and adequate surgical intervention. The purpose was to identify typical preoperative sonographic changes of the venous system in patients with varicose veins of the lower extremities with connective tissue dysplasia. Materials and methods. One-hundred and four patients with varicose veins of the lower extremities were preoperatively examined for typical clinical, phenotypic and biochemical markers of undifferentiated connective tissue dysplasia and divided into two groups according to the presence or absence of connective tissue dysplasia manifestations. Then, during preoperative preparation sonographic features were identified by ultrasound scanning using standard protocol for examination. Results. The form of varicose veins was determined in all patients. In patients with dysplasia symptoms mixed form dominated (23 (67.65 %) patients). During measuring main venous trunks the patients of this group had mainly thinning of vein walls, with significantly expanded diameters, reduced contractility, increased rigidity. In some places the walls of veins were significantly thinned. Valve unit worked poorly with signs of failure, which manifested by hemodynamic significant vertical and horizontal reflux. Reflux was mainly decompensated with retrograde blood flow over 1.5–3 seconds. Valve failure was observed in the superficial and deep veins. The patients often had abnormalities of sapheno-femoral junction: aneurysm extensions (7 (20.59 %)); tortuous great saphenous vein looking like a cluster of grape (4 (11.76 %)); real doubling the main trunk of the thigh (7 (20.59 %)) and shin (3 (8.82 %)). Also in this group of patients (23 (67.65 %)) widespread and combined varicose process of the main trunk in thighs and shins predominated. In addition, multiple perforating veins failure was observed, mainly in shins with hemodynamic significant reflux at these levels. Conclusions. Restructuring of the connective tissue in patients with symptoms of connective tissue dysplasia significantly affect the state of the venous system of the lower extremities, namely its functionality, which can be efficiently evaluate today with ultrasound scanning. In these patients sapheno-femoral junction valve failure with pronounced vertical reflux along a significant segment of the limb prevails. Perforating veins of shin and foot manifested with horizontal refluxes at their levels. In 2/3 patients mixed form of varicose vein of the low extremities was diagnosed that confirms the prevalence of venous system lesions with more severe varicose of the main venous structures. More often different configurations of vein aneurysm are determined, both in the area of junctions and along the venous trunk.
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