Quantifizierung des Effekts von Varizenoperationen auf die venöse Hämodynamik mittels des veno-arteriellen Flow-Index (VAFI)

Haben medizinische Kompressionsstrümpfe im Liegen einen hämodynamischen Effekt?

Medizinische Kompressionsstrümpfe (MKS) bilden die Grundlage in der Therapie chronischer Venenerkrankungen. Aufgrund mangelnder Studiendaten über deren Auswirkung auf die Hämodynamik im Liegen kann für ihr Tragen in horizontaler Körperlage bisher jedoch keine klare Empfehlung gegeben werden. In folgender Kasuistik wurde der hämodynamische Effekt von MKS der Klasse 1 bei einer Patientin mit venentypischen Beschwerden im Stadium C4 über die Erhebung des veno-arteriellen Flow-Index (VAFI) quantitativ untersucht. Unter Kompression mit MKS zeigten sowohl die duplexsonografischen als auch die mittels Phasenkontrast-MRT akquirierten Messdaten eine deutliche Verbesserung der hämodynamischen Verhältnisse in Rückenlage. Dieser Krankheitsfall zeigt, dass das Tragen von MKS im Liegen insbesondere bei Immobilität einen therapeutischen Mehrwert bringen kann.

Are Sonographically Measured Vascular Haemodynamic Parameters Reproducible Using Magnetic Resonance Imaging?

OBJECTIVE/BACKGROUND

Hemodynamic measurements of blood flow in the common femoral vein and artery can be performed readily using duplex sonography. The ratio of venous to arterial volume flow in these vessels, the venous arterial flow index (VAFI), is increased in patients with varicose veins and/or chronic venous disease. The objective was to determine the reproducibility of sonographically measured hemodynamic flow parameters using phase contrast magnetic resonance imaging (MRI).

METHODS

Based on hemodynamic volume flow measurements from the common femoral vein and artery the VAFI was calculated in seven patients with varicose veins (C2, Ep, As, Pr) and 32 healthy controls using standard duplex sonography and MRI.

RESULTS

Based on duplex sonography, the average VAFI (VAFI_{_d}) was 1.05 ± 0.17. The same ratio, using MRI (VAFI__mri) was 1.05 ± 0.19. There was a significant correlation between the VAFI_{_d} and the VAFI__MRI (p = .0021). In patients with venous disease, the average VAFI_{_d} and VAFI__mri were 1.36 ± 0.21 and 1.36 ± 0.20, respectively. In contrast, in the healthy cohort the VAFI_{_d} was 1.00 ± 0.12 and the VAFI__mri measured 1.01 ± 0.15. As expected, there was a significant difference between the VAFI measured in those with venous disease when compared with that of healthy controls (p < .0001).

CONCLUSION

There is a significant correlation between the VAFI measured using sonography and MRI. The study confirmed the elevation of VAFI in patients with chronic venous disease.

Efficacy of sclerotherapy in varicose veins-- prospective, blinded, placebo-controlled study

OBJECTIVE

The objective of this study was to investigate the efficacy of sclerotherapy for varicose veins in a randomized blinded study.

METHODS

Twenty-five patients with varicose veins (C(2-4), E(P), A(SP), P(R)) were included. Fourteen subjects received polidocanol (Aethoxysklerol) and 11 patients received normal saline injections. Compression was applied for 1 week. One, 4, and 12 weeks later controls were performed using duplex ultrasonography. The quotient of venous by arterial volume flow was used as quantitative hemodynamic pattern. Patients and the examiner were unaware of which liquid had been injected.

RESULTS

In comparison to group 2, 76.8% of the veins treated with polidocanol were completely occluded (p<0.0001). In group 1 the venoarterial flow index decreased from 1.45+/-0.66 to 1.06+/-0.2 (p=0.05). In 11 occluded veins of 14 (group 1), the venoarterial flow index decreased from 1.5+/-0.07 to 0.98+/-0.12 (p<0.05), which is a level found in competent veins. In group 2, the venoarterial flow index remained stable increased.

CONCLUSIONS

Injection sclerotherapy using polidocanol (Aethoxysklerol) is efficient to obliterate varicose veins and to improve venous hemodynamics.