Клинико-ультразвуковые показатели большой и малой подкожных вен при хронической венозной недостаточности: проспективное исследование

Introduction: Chronic venous insufficiency (CVI) is a pathological condition characterized by impaired outflow of venous blood from the lower extremities to the heart. CVI is one of the most common chronic diseases worldwide and is associated with high prevalence, age-related factors, geographical variations, and significant socioeconomic burden. In our study, we focused on differences in anthropometric parameters (internal lumen diameter) of the main subcutaneous veins of the lower extremities between healthy volunteers and patients with different classes of chronic venous insufficiency according to the CEAP (2020) classification.

Objective: To determine the relationship between the diameters of the great saphenous vein (GSV) and the small saphenous vein (SSV) in both lower limbs and the stages of chronic venous insufficiency (CVI) C3–C6 according to the CEAP (2020) classification, as well as the number of affected main trunks.

Materials and Methods: Ultrasound angioscanning was performed on a Mindray DC-70 (China) (5–12 MHz sensor) of the subcutaneous veins of the lower extremities of 165 patients: 20 volunteers without US-signs of damage to the venous system, 100 patients with varicose veins of class C3–C4а and 45 patients with active trophic ulcers of venous etiology that corresponded to class C6 according to the CEAP classification. The internal lumen of LSV and SSV was measured on both lower limbs at different levels. Statistics: The analysis was performed in SPSS 26.0. The normality of the distribution was tested using the Kolmogorov-Smirnov test. Group comparisons were made using Student’s t-test. The significance level was set at p < 0.05.

Results: LSV diameter significantly increases from normal (3.3±0,5 mm) to classes C3–C4а (6.8±1.6 mm, p < 0.001) and C6 (8.1±1.7 mm, p <0,01) according to CEAP (2020); SSV is significantly wider in patients with CVI (up to 6.3 mm) compared with healthy volunteers (1.9±0.3 mm, p < 0.001), but without significant differences between C3–C4а and C6. DISCUSSION: According to the US study, the diameter of the LSV trunk significantly increases as CVI progresses to classes C3–C4а and C6 and can serve as a marker of disease severity. The absence of a significant increase in the diameter of the SSV trunk during the transition from class C3–C4а to class C6 emphasizes the leading role of LSV in the pathogenesis of trophic disorders in the soft tissues of the lower extremities in CVI. It was also observed that impaired venous outflow with a large number of affected mains significantly impairs tissue trophism in the zone of trophic ulcer formation.

Conclusion: Thus, as a result of our study using ultrasound duplex scanning of the lower extremity veins, we found that the trunk diameter of the great saphenous veins significantly increased with the progression of chronic venous insufficiency to CEAP (2020) classes C3–C4а and C6. This can also serve as an additional marker of disease severity, which is consistent with the clinical guidelines for this pathology. At the same time, the absence of a significant increase in the trunk diameter of the small saphenous vein during the transition from class C3–C4а to class C6 underscores the leading role of the GSV in the pathogenesis of trophic disorders in the soft tissues of the lower extremities in CVI. With the progression of the pathology involving a large number of affected main trunks, the impairment of venous outflow significantly worsens tissue trophism in the area of trophic ulcer formation.

1. Rabe E., Pannier F. Epidemiology of chronic venous disorders // International Angiology. 2018. Vol. 37. P. 181–254. doi: 10.23736/S0392-9590.18.04001-7.

2. Lurie F., Passman M. Clinical practice guidelines for chronic venous disease // Journal of Vascular Surgery. 2020. Vol. 71. P. 220–261. doi: 10.1016/j.jvs.2019.12.075.

3. Nicolaides A.N. Ultrasound diagnosis of venous insufficiency // International Angiology. 2019. Vol. 38. P. 105–127. doi: 10.23736/S0392-9590.19.04133-3.

4. Mendoza E. Pathophysiology and management of venous ulcers // Phlebology. 2017. Vol. 32. P. 478–485. doi: 10.1177/0268355516687865.

5. Савельев В.С. Ультразвуковые критерии диагностики варикозной болезни // Флебология. 2021. Т. 15, № 2. С. 45–52.

6. Gloviczki P., Comerota A.J., Dalsing M.C., Eklof B.G., Gillespie D.L., Gloviczki M.L., Lohr J.M., McLafferty R.B., Meissner M.H., Murad M.H., Padberg F.T., Pappas P.J., Passman M.A., Raffetto J.D., Vasquez M.A., Wakefield T.W.; Society for Vascular Surgery; American Venous Forum. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum // J. Vasc. Surg. 2011. May; Vol. 53 (5 Suppl.). Р. 2S-48S. doi: 10.1016/j.jvs.2011.01.079. PMID: 21536172.

7. Nicolaides A.N. et al. Management of chronic venous disorders of the lower limbs: guidelines according to scientific evidence // International Angiology. 2020. Vol. 39, No. 3. P. 175–240. doi: 10.23736/S0392–9590.20.04389-6.

8. Mansilha A. et al. Hemodynamic and clinical impact of ultrasound-derived venous reflux parameters // Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2022. Vol. 10, No. 1. P. 125–132. doi: 10.1016/j.jvsv.2021.06.019.

9. Lurie F. et al. The 2022 update of the CEAP classification system and reporting standards // Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2023. Vol. 11, No. 1. P. 5–9. doi: 10.1016/j.jvsv.2022.09.004.

10. Rabe E. et al. Indications for compression therapy in venous and lymphatic disease: consensus document // Phlebology. 2021. Vol. 36, No. 3. P. 163–184. doi: 10.1177/0268355520963946.

11. Kistner R.L. et al. Update on the surgical treatment of venous reflux disease // Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2021. Vol. 9, No. 1. P. 37–46. doi: 10.1016/j.jvsv.2020.06.014.

12. Cavezzi A. Duplex ultrasound in chronic venous insufficiency // European Journal of Vascular and Endovascular Surgery. 2019. Vol. 58. P. 123–134. doi: 10.1016/j.ejvs.2019.02.022.

13. Raffetto J.D. Venous wall remodeling in chronic venous disease // Journal of Vascular Surgery. 2020. Vol. 72. P. 726–735. doi: 10.1016/j.jvs.2019.11.050.

14. Lee B.B. The role of small saphenous vein in chronic venous disorders // Phlebology. 2022. Vol. 37. P. 5–14. doi: 10.1177/02683555211035500.

15. Кириенко А.И., Богачев В.Ю., Гаврилов С.Г. Современные подходы к лечению хронической венозной недостаточности // Анналы хирургии. 2020. № 3. С. 34–41.

16. Panpikoon T., Metheekul P., Treesit T., Bua-Ngam C., Sriprachyakul A., Pichitpichatkul K. Diameter-reflux relationship of the saphenous vein in the C0–C3 patients of chronic venous disease // Phlebology. 2022. Jul; Vol. 37, No. 6. Р. 439–444. doi: 10.1177/02683555221088105.

17. Liu H., Li L., Wei W., Tang Y., Liu L., Xiao C. Correlation between popliteal vein functional diameter and the severity of chronic venous disease // Phlebology. 2025. Jul; Vol. 40, No. 6. Р. 415–419. doi: 10.1177/02683555241310531.

18. Yang Q., Zhao Y., Chen X., Tang P., Li L., Zhao J., Han Y., Wu D., An L., Zhang B., Zhou X., Liu L., Chi Y.W. 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. Mar; Vol. 9, No. 2. Р. 401–408.e1. doi: 10.1016/j.jvsv.2020.07.006. Epub 2020 Jul 28. PMID: 327309.

19. Главнов П.В., Серебрякова С.В., Варзин С.А. Клинические и ультразвуковые корреляции при варикозной болезни // Вестник Санкт-Петербургского университета. Медицина. 2025. № 20. С. 70–80. https://doi.org/10.21638/spbu11.2025.106.