Introduction. During the last several decades there have been many new methods introduced for the treatment of lower limb chronic venous insufficiency (laser, foam, subendothelial and thermal coagulation methods). Venous system of lower limbs often presents anatomic variations including venous duplications. Knowledge of venous system variations in the lower limb area is of particular importance due to correct interpretation of imaging in relation to deep vein thrombosis (DVT). There was only a small number of studies published on anatomic variations of venous system in the lower limbs. To the best of our knowledge there have been no previous studies on anatomic variations of lower limb deep venous system performed in Latvia.
Aim of the study. To retrospectively review of 216 patients (432 lower limbs) phlebograms in order to establish deep venous system anatomic variations in Latvian population and compare our results to other publications.
Materials and methods. Retrospective analysis of 432 lower limb phlebograms performed at Pauls Stradins Clinical University Hospital (Riga, Latvia) of 216 patients treated in different ortopedic centers of Latvia during 2009 and 2012. Assessment made using DICOM Synedra view personal software. Study protocol was developed for definition of veins and assessment of phlebogram images in accordance with anatomic definitions used in previous studies. Two independent radiologists assessed data. Visualised duplications in the deep venous system of both lower limbs in patients were registered (common iliac vein, external iliac vein, common femoral vein, femoral vein, deep femoral vein, popliteal vein). Blood vessels have been listed as single, double or triple / complex. The presence of DVT was recorded upon assessment of phlebograms. Statistical analysis performed using SPSS 20.0 software (IBM). Parametric data comparison performed using Student t-test and ANOVA. Non-parametric data comparison performed using chi-square and Mann Whitney tests. Data comparison type was assessed using Kolmogorova-Smirnovs test. The results are presented as the average ± standard deviation.
Results. Retrospective analysis of 432 lower limb phlebograms was performed in 216 patients. Average age of the patients was 34.4 years (range 19-90). 101 patients were female (47%) and 115 (53%) were male with no statistical venous variation differences found between two genders, which is explained by both age and gender (p > 0.05). Analysis of calf vein, popliteal vein and femoral venous variations provided a strong correlation between larger number of duplications in one limb and possibility of such variations in the other limb of the same patient (all p < 0.001).
Conclusion. We conclude that there are frequent anatomic variations in SFV and popliteal veins seen in Latvian population. All patients included in this study had high DVT risk, much higher than in the average Latvian population. In almost every sixth Latvian person there is some form of deep veins hypoplasia found.
1. Eifert S, Villavicencio JL, Kao TC, Taute BM, Rich NM. Prevalence of deep venous anomalies in congenital vascular malformations of venous predominance // J Vasc Surg, 2000 Mar; 31(3):462-71.
2. Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study// J Epidemiol Community Health, 1999; 53:149-153.
3. Liu GC, Ferris EJ, Reifsteck JR, Baker ME. Effect of anatomic variations on deep venous thrombosis of the lower extremity // AJR Am J Roentgenol, 1986; 146:845-848.
4. Park EA, Chung JW, Lee W, Yin YH, Ha J, Kim SJ, Park SH. Three-Dimensional Evaluation of the Anatomic Variations of the Femoral Vein and Popliteal Vein in Relation to the Accompanying Artery by Using CT Venography // Korean J Radiol, 2011 May-Jun; 12(3): 327-340.
5. Quinlan DJ, Alikhan R, Gishen P, Sidhu PS. Variations in Lower Limb Venous Anatomy: Implications for US Diagnosis of Deep Vein Thrombosis // Radiology, 2003; 228:443-448
6. White RH. Epidemiology of Venous Thromboembolism // Circulation, 2003; 107 (23) I-3.
7. Paiement GD, Mendelsohn C. The risk of venous thrombembolism in the orthopedic patient: epidemiological and physiological data // Orthopedics, 1997; 20 Suppl:7-9.