Clinical and pathophysiological characteristics of hemodynamic alterations in patients with lower extremity varicose veins
DOI:
https://doi.org/10.14739/2310-1210.2026.1.340601Keywords:
chronic venous disease of the lower extremities, vascular disease, operative surgical procedures, endovenous ablation, venous duplex scanning, varicose veins, venous insufficiencyAbstract
Chronic venous disease (CVD) of the lower extremities, specifically at the stage of chronic venous insufficiency, is a prevalent condition among adults characterized by a progressive clinical course and declining quality of life. This necessitates a detailed assessment of hemodynamic changes within the venous system.
Aim. To identify the clinical and pathophysiological features of hemodynamic changes prior to surgery and determine their association with the clinical class of the disease.
Materials and methods. The study included 139 patients (aged 18–75 years) with CVD classes C3–C6 (CEAP classification). Patients were divided into three groups with subgroups based on the treatment method. Assessment included clinical examination, duplex scanning (measuring diameters of the saphenofemoral and saphenopopliteal junctions (SFJ and SPJ), great and small saphenous veins (GSV and SSV), tributaries, and perforators). Disease severity was evaluated using the Venous Clinical Severity Score (VCSS), and quality of life using the Chronic Venous Insufficiency Questionnaire (CIVIQ-20). Statistical analysis utilized Student’s t-test and Pearson correlation coefficient (r).
Results. A statistically significant direct correlation was found between higher CEAP clinical classes and worsening CIVIQ-20 and VCSS scores (p < 0.05). Duplex ultrasound revealed a strong positive correlation between disease progression and increased diameters of the GSV, SSV, SFJ, and SPJ, as well as a greater number and size of tributaries and perforators with pathological reflux. The number of affected anatomical segments in the superficial venous system also increased with disease severity.
Conclusions. Combined analysis of duplex data, CIVIQ-20, and VCSS is critical for optimal surgical decision-making. Future studies should prioritize elucidating the biochemical mechanisms underlying CVD progression and assessing the long-term outcomes associated with various surgical approaches.
References
Savoliuk SI. Suchasnyj pohlyad na likuvannya uskladnenykh form khronichnoyi venoznoyi nedostatnosti [Internet]. Khirurhiia. Ortopediia. Travmatolohiia. Intensyvna terapiia. 2023;(1) [cited 2025 Sep 19]. Available from: https://health-ua.com/hirurgiya/flebologiia/72731-suchasnij-poglyad-nalkuvannya-uskladnenih-form-hronchno-venozno-nedostatnos. Ukrainian.
Aslam MR, Muhammad Asif H, Ahmad K, Jabbar S, Hayee A, Sagheer MS, et al. Global impact and contributing factors in varicose vein disease development. SAGE Open Medicine. 2022;10:20503121221118992. doi: https://doi.org/10.1177/20503121221118992
Babaei M, Afrooghe A, Rafati A, Mohebbi B, Moosavi J, Ghadri N, et al. Prevalence and associated factors of chronic venous disease among the modern Iranian urban population. J Vasc Surg Venous Lymphat Disord. 2023;11(6):1098-106.e10. doi: https://doi.org/10.1016/j.jvsv.2023.06.005
Wang Y, Li R, Bai L, Zou Z, Zheng C, Peng F, et al. A study of social isolation in patients with varicose veins of the lower extremities: A scoping review. J Tissue Viability. 2024;33(4):930-7. doi: https://doi.org/10.1016/j.jtv.2024.09.012
Michaels JA, Nawaz S, Tong T, Brindley P, Walters SJ, Maheswaran R. Varicose veins treatment in England: population-based study of time trends and disparities related to demographic, ethnic, socioeconomic, and geographical factors. BJS Open. 2022;6(4):zrac077. doi: https://doi.org/10.1093/bjsopen/zrac077
Salim S, Machin M, Patterson BO, Onida S, Davies AH. Global epidemiology of chronic venous disease: A systematic review with pooled prevalence analysis. Annals of Surgery. 2021;274(6):971-6. doi: https://doi.org/10.1097/SLA.0000000000004631
Gao Y, Sun M, Qin J, Wang X. Clinical study of the venous structure and hemodynamic status of patients with varicose veins of the lower limbs by bifunctional ultrasound scanning. Minerva Med. 2025;116(6):510-3. doi: https://doi.org/10.23736/S0026-4806.24.09105-5
Atik C, Ozcaliskan O, Atik D. 5-year clinical results of 1073 patients with varicose veins treated using radiofrequency ablation, endovenous laser ablation and cyanoacrylate embolisation. Sanamed. 2023;18(1):45-52. doi: https://doi.org/10.5937/sanamed18-43961
Ma Y, Zhang H, Niu L, Feng Y, Zhang C, Zhang F, et al. The long-term efficacy of radiofrequency ablation for varicose veins in patients with iliac vein compression. Asian J Surg. 2024:S1015-9584(24)02697-6. doi: https://doi.org/10.1016/j.asjsur.2024.11.071
Pavuk FM, Fedusiak VY, Popovych NM. [Results of complex treatment of patients with chronic venous insufficiency in the stage of decompensation]. Scientific Bulletin of Uzhhorod University. Series Medicine. 2023;(2):101-6. Ukrainian. doi: https://doi.org/10.32782/2415-8127.2023.68.17
Rahman MS, Sayem MA, Khan MK, Alam MR, Azad MA. Outcome of varicose vein surgery in a general surgical unit. International Surgery Journal. 2024;11(3):345-9. doi: https://doi.org/10.18203/2349-2902.isj20240565
Donmez GS, Basak T. Evaluation of quality of life in patients with varicose veins of the lower extremities. International Journal of Emerging Trends in Health Sciences. 2020;4(1):1-10. doi: https://doi.org/10.18844/ijeths.v4i1.4965
Gwozdzinski L, Pieniazek A, Gwozdzinski K. Factors influencing venous remodeling in the development of varicose veins of the lower limbs. Int J Mol Sci. 2024;25(3):1560. doi: https://doi.org/10.3390/ijms25031560
Kolosovych IV, Korolova KO, Korolova ZV. Pathophysiological mechanisms of varicose veins in the lower extremities. Fiziologichnyi Zhurnal. 2025;71(1):79-86. doi: https://doi.org/10.15407/fz71.01.079
Krasiński Z, Krasińska B. Treatment of early-stage chronic venous disease – management standards for 2023. Polski Przegląd Chirurgiczny. 2023;95(1):64-9. doi: https://doi.org/10.5604/01.3001.0016.2971
Hong KP. Correlation of clinical class with duplex ultrasound findings in lower limb chronic venous disease. J Chest Surg. 2022;55(3):233-8. doi: https://doi.org/10.5090/jcs.22.010
Sarpe AK, Flumignan CD, Nakano LC, Trevisani VF, Lopes RD, Guedes Neto HJ, et al. Duplex ultrasound for surveillance of lower limb revascularisation. Cochrane Database of Systematic Reviews. 2023;7(7):CD013852. doi: https://doi.org/10.1002/14651858.CD013852.pub2
Zegarra TI, Tadi P. CEAP classification of venous disorders [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan– [updated 2023 Mar 27; cited 2025 Sep 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557410/
Gloviczki P, Lawrence PF, Wasan SM, Meissner MH, Almeida J, Brown KR, et al. The 2022 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 I. Duplex scanning and treatment of superficial truncal reflux: Endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord. 2023;11(2):231-261.e6. doi: https://doi.org/10.1016/j.jvsv.2022.09.004
Darwis P, Pratama D, Muradi A, Hamzah A, Rizqhi F, Satriadinatha GB. Adaptation of the CIVIQ-20 Questionnaire as a measurement instrument on quality of life in chronic venous insufficiency patients in Jakarta, Indonesia. Chirurgia. 2024;37(4):243-6. doi: https://doi.org/10.23736/S0394-9508.23.05666-8
Launois R, Mansilha A, Jantet G. International psychometric validation of the Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-20). Eur J Vasc Endovasc Surg. 2010;40(6):783-9. doi: https://doi.org/10.1016/j.ejvs.2010.03.034
Bai H, Storch JB, Gokani V, Kibrik P, Chen J, Ting W. Identifying venous clinical severity score thresholds for Clinical-Etiology-Anatomy-Pathophysiology classifications of venous edema and higher. Vascular. 2024 Dec;32(6):1322-1329. doi: https://doi.org/10.1177/17085381231193510
Fetisov VS. Paket statystychnoho analizu danykh STATISTICA (Statistical data analysis package STATISTICA). Nizhyn: Mykola Gogol Nizhyn State University; 2018. 114 p. Ukrainian.
Tereshkevych HТ. Osnovy bioetyky ta biobezpeky [Fundamentals of bioethics and biosafety]. Ternopil: TDMU; 2018. 400 p. Ukrainian.
Verkhovna Rada of Ukraine. On Medicinal Products. Law of Ukraine dated 1996 Apr 4 No. 123/96-BP. [cited 2025 Mar 8]. Available from: https://zakon.rada.gov.ua/laws/show/123/96-вр#Text
European Parliament and Council of the European Union. Directive 2001/20/EC on the approximation of the laws, regulations and administrative provisions of the Member States relating to the implementation of good clinical practice in the conduct of clinical trials on medicinal products for human use [Internet]. 2001 Apr 4 [cited 2025 Sep 19]. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32001L0020
Council of Europe. Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Oviedo Convention (ETS No. 164) [Internet]. 1997 Apr 4 [cited 2025 Sep 19]. Available from: https://www.coe.int/en/web/human-rights-and-biomedicine/oviedo-convention
World Medical Association. Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Participants [Internet]. [cited 2025 Mar 8]. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki/
World Health Organization. WHO guidelines on ethical issues in public health surveillance. Geneva: World Health Organization; 2017. 66 p.
European Medicines Agency. Good clinical practice [Internet]. [cited 2025 Sep 19]. Available from: https://www.ema.europa.eu/en/human-regulatory-overview/research-development/compliance-research-development/good-clinical-practice
Ministry of Health of Ukraine. [On approval of the procedure for conducting clinical trials of medicinal products and examination of clinical trial materials and model regulation on ethics committees. Order dated 2009 Sep 23 No. 690] [Internet]. 2009 [cited 2025 Jul 9]. Available from: https://zakon.rada.gov.ua/laws/show/z1010-09#Text
Wąs M, Latała A, Zozula N, Rykucka A, Kiełbasa J, Kowalczyk A, et al. Treatment methods for varicose veins of the lower limbs. J Educ Health Sport. 2024;74:52561. https://dx.doi.org/10.12775/JEHS.2024.74.52561
Yun S. Clinical implications of venous hypertension in the management of chronic venous disease. Ann Phlebology. 2024;22(2):71-3. doi: https://doi.org/10.37923/phle.2024.22.2.71
Pugalenthi LS, Garapati C, Maddukuri S, Kanwal F, Kumar J, Asadimanesh N, et al. From data to decisions: AI in varicose veins – predicting, diagnosing, and guiding effective management. J Vasc Dis. 2025;4(2):19. doi: https://doi.org/10.3390/jvd4020019
Shrestha B, Karmacharya RM. Influence of body mass index (BMI), age and gender on stages of varicose vein in newly diagnosed cases following screening Doppler in outpatient clinic. Kathmandu Univ Med J. 2020; 18(69):28-31.
Hong K. The 2020 update of the CEAP classification: updated contents and background. Ann Phlebology. 2022;20:19-23. doi: https://doi.org/10.37923/phle.2022.20.1.1
Atamaniuk OY, Skrypko VD, Atamaniuk VM, Bybliuk YY. Relationship between ultrasonographic criteria, clinical manifestations and life quality parameters in patients with lower extremity varicose vein disease. World of Medicine and Biology. 2022;(2):13-8. doi: https://doi.org/10.26724/2079-8334-2022-2-80-13-18
Lahel RS, Chail AS, Kumar SM. Determination of cutoff diameter of great saphenous vein as indicative of saphenofemoral junction incompetence in cases of varicose veins. J Mar Med Soc. 2024;26(1):15-8. doi: https://doi.org/10.4103/jmms.jmms_173_22
Alghamdi DA, Al-Shehri RH, Al-Qahtani MF, Mehmood UA. The effect of varicose veins on the quality of life of adult female patients in the Eastern region of Saudi Arabia. Open Public Health J. 2020;13(1):771-8. doi: https://doi.org/http://dx.doi.org/10.2174/1874944502013010771
Aslam MR, Asif HM, Ahmad K, Jabbar S, Hayee A, Sagheer MS, et al. Global impact and contributing factors in varicose vein disease development. SAGE Open Med. 2022;10:205031212211189. doi: https://doi.org/10.1177/20503121221118992
Santiago FR, Ulloa J, Regnier C, Peudon T, Braund E, Fradet-Aubignat C, et al. The impact of lower limb chronic venous disease on quality of life: patient and physician perspectives. J Comp Eff Res. 2022;11(11):787-801. doi: https://doi.org/10.2217/cer-2022-0054
Yang Q, Zhao Y, Chen X, Tang P, Li L, Zhao J, et al. Association between vein diameters, reflux characteristics, and clinical severity in patients with chronic venous insufficiency in Northwest China. J Vasc Surg Venous Lymphat Disord. 2021;9(2):401-408.e1. doi: https://doi.org/10.1016/j.jvsv.2020.07.006
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