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Perforator vein incompetence in chronic venous disease: a multivariate regression analysis model.
J Vasc Surg 2004; 40(4):626-33JV

Abstract

OBJECTIVES

In the presence of superficial and deep vein insufficiency the effects, if any, of concurrent incompetent perforator veins (IPVs) on clinical status are masked. On the basis of multivariate regression analysis, this study examines the significance of perforator vein incompetence across the clinical classes of CEAP (C-class CEAP) in relation to the superficial and deep systems, and assesses the role of factors implicated in the presence and number of IPVs in chronic venous disease (CVD).

METHODS

The study included 525 limbs in 360 patients, ages 17 to 96 years, referred for investigation of CVD. The protocol entailed history taking, physical examination, and duplex scanning (reflux > 0.5 s), with emphasis on IPVs. Exclusion criteria included peripheral vascular disease, unrelated edema, severe chronic obstructive pulmonary disease, and recent (< 1 year) deep vein thrombosis (DVT).

RESULTS

Limbs were stratified as C 0 , 84; C 1 , 25; C 2 , 231; C 3 , 66; C 4 , 48; C 5 , 23; and C 6 , 48. C-class CEAP was separately regressed with age (P < .001), sex (P < .25), contralateral CVD (P < .2), CVD recurrence (P = .022), previous DVT (P < .001), superficial vein reflux (P < .001); deep vein reflux (P < .001), perforator vein reflux (P < .001), and number of IPVs (P < .001). In an optimized multivariate regression analysis of C class CEAP with all significant variables combined, age (P < .001), previous DVT (P = .017), superficial vein reflux (P < .001), deep vein reflux (P < .001), and number of IPVs (P = .008) emerged as predictors of CVD severity (CEAP), based on the equation C class CEAP = -0.2807 + 0.028013 Age + 0.58530 Previous DVT + 0.3450 Superficial vein reflux + 0.17781 Deep Reflux + 0.14537 IPVs (R 2 = 37.4%; P < .001). Perforator incompetence was predicted by superficial vein reflux (P < .001) and deep vein reflux (P = .044), age (P = .019), CVD recurrence (P = .038), and sex (P = .018), as follows: Perforator incompetence = -0.2532 + 0.006457 Age + 0.41366 Superficial reflux + 0.06766 Deep reflux + 0.2450 CVD recurrence - 0.21310 Sex (R 2 = 33.3%; P < .001). Number of IPVs per limb was best associated with superficial reflux (P < .001) and deep reflux (P = .023), linked as IPVs = - 0.11789 + 0.41323 Superficial reflux + 0.07646 Deep reflux (R 2 = 26.1%; P < .001).

CONCLUSION

Perforator incompetence proved to be a significant factor for determination of CVD severity according to C-class CEAP , withstanding the conspicuous confounding effects of the superficial and deep venous systems. Perforator incompetence was significantly linked to aging, superficial or deep vein incompetence, recurrence of superficial disease, and sex, whereas the IPV number, regardless of location, depended on the presence of superficial or deep venous reflux.

Authors+Show Affiliations

Department of Vascular Surgery, St. Mary;s Hospital, Imperial College School of Medicine. k.delis@ic.ac.uk

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15472587

Citation

Delis, Konstantinos T.. "Perforator Vein Incompetence in Chronic Venous Disease: a Multivariate Regression Analysis Model." Journal of Vascular Surgery, vol. 40, no. 4, 2004, pp. 626-33.
Delis KT. Perforator vein incompetence in chronic venous disease: a multivariate regression analysis model. J Vasc Surg. 2004;40(4):626-33.
Delis, K. T. (2004). Perforator vein incompetence in chronic venous disease: a multivariate regression analysis model. Journal of Vascular Surgery, 40(4), pp. 626-33.
Delis KT. Perforator Vein Incompetence in Chronic Venous Disease: a Multivariate Regression Analysis Model. J Vasc Surg. 2004;40(4):626-33. PubMed PMID: 15472587.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perforator vein incompetence in chronic venous disease: a multivariate regression analysis model. A1 - Delis,Konstantinos T, PY - 2004/10/9/pubmed PY - 2004/11/17/medline PY - 2004/10/9/entrez SP - 626 EP - 33 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 40 IS - 4 N2 - OBJECTIVES: In the presence of superficial and deep vein insufficiency the effects, if any, of concurrent incompetent perforator veins (IPVs) on clinical status are masked. On the basis of multivariate regression analysis, this study examines the significance of perforator vein incompetence across the clinical classes of CEAP (C-class CEAP) in relation to the superficial and deep systems, and assesses the role of factors implicated in the presence and number of IPVs in chronic venous disease (CVD). METHODS: The study included 525 limbs in 360 patients, ages 17 to 96 years, referred for investigation of CVD. The protocol entailed history taking, physical examination, and duplex scanning (reflux > 0.5 s), with emphasis on IPVs. Exclusion criteria included peripheral vascular disease, unrelated edema, severe chronic obstructive pulmonary disease, and recent (< 1 year) deep vein thrombosis (DVT). RESULTS: Limbs were stratified as C 0 , 84; C 1 , 25; C 2 , 231; C 3 , 66; C 4 , 48; C 5 , 23; and C 6 , 48. C-class CEAP was separately regressed with age (P < .001), sex (P < .25), contralateral CVD (P < .2), CVD recurrence (P = .022), previous DVT (P < .001), superficial vein reflux (P < .001); deep vein reflux (P < .001), perforator vein reflux (P < .001), and number of IPVs (P < .001). In an optimized multivariate regression analysis of C class CEAP with all significant variables combined, age (P < .001), previous DVT (P = .017), superficial vein reflux (P < .001), deep vein reflux (P < .001), and number of IPVs (P = .008) emerged as predictors of CVD severity (CEAP), based on the equation C class CEAP = -0.2807 + 0.028013 Age + 0.58530 Previous DVT + 0.3450 Superficial vein reflux + 0.17781 Deep Reflux + 0.14537 IPVs (R 2 = 37.4%; P < .001). Perforator incompetence was predicted by superficial vein reflux (P < .001) and deep vein reflux (P = .044), age (P = .019), CVD recurrence (P = .038), and sex (P = .018), as follows: Perforator incompetence = -0.2532 + 0.006457 Age + 0.41366 Superficial reflux + 0.06766 Deep reflux + 0.2450 CVD recurrence - 0.21310 Sex (R 2 = 33.3%; P < .001). Number of IPVs per limb was best associated with superficial reflux (P < .001) and deep reflux (P = .023), linked as IPVs = - 0.11789 + 0.41323 Superficial reflux + 0.07646 Deep reflux (R 2 = 26.1%; P < .001). CONCLUSION: Perforator incompetence proved to be a significant factor for determination of CVD severity according to C-class CEAP , withstanding the conspicuous confounding effects of the superficial and deep venous systems. Perforator incompetence was significantly linked to aging, superficial or deep vein incompetence, recurrence of superficial disease, and sex, whereas the IPV number, regardless of location, depended on the presence of superficial or deep venous reflux. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/15472587/Perforator_vein_incompetence_in_chronic_venous_disease:_a_multivariate_regression_analysis_model_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S074152140400922X DB - PRIME DP - Unbound Medicine ER -