Measuring diameters of great saphenous vein and common femoral vein using duplex ultrasound

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1 263 Mesuring imeters of gret sphenous vein n ommon femorl vein using uplex ultrsoun E. Menoz Vein prtise, Wunstorf, Germny Keywors, gret sphenous vein, ommon femorl vein, venous imeter Summry For yers, mesurement of the imeter of the gret sphenous vein n, osionlly, the ommon femorl vein hs een omponent of mny linil stuies on vriose vein tretment. There is onsensus tht the mesurements shoul e onute with the ptient in the stning position n with trnsverse view through the vein, ut no stnrise site of mesurement of the venous imeter hs yet een estlishe. The shpe of the gret sphenous vein vries gretly t the sphenofemorl juntion. Due to the urvture of the gret sphenous vein, it is iffiult to fin point t whih the trnsverse view mesure is t right ngles to the ourse of the vein. Aoring to the ville t, the optiml site for mesuring the gret sphenous vein imeter is the proximl thigh. When mesuring the ommon femorl vein, trnsverse view immeitely istl to the juntion of the gret sphenous vein is suggeste n stuies hve lso onfirme this. Shlüsselwörter Duplexsonogrphie, Ven sphen mgn, Ven femorlis ommunis, Venenurhmesser Zusmmenfssung Die Erheung er Durhmesser er V. sphen mgn ist seit Jhren Bestnteil vieler klinisher Stuien zur Therpie er Vrikose, gelegentlih uh er Durhmesser er V. femorlis ommunis. Es esteht Konsens rin, ss ie Messungen m stehenen Menshen urhgeführt weren un uf einem Quershnitt urh ie Vene erhoen weren. Der Ort er Erheung er Durhmesser ist jeoh noh niht stnrisiert. Die V. sphen mgn weist in er Münung eine hohe Formvriilität uf. Durh ie Krümmung er V. sphen mgn eingt fällt es shwer, einen Punkt zu finen, n em er erhoene Quershnitt senkreht zum Venenverluf liegt. Der nh Dtenlge este Messpunkt er Durhmesser er V. sphen mgn ersheint m proximlen Oershenkel. Für ie Messung er V. femorlis ommunis wir ein Quershnitt unmittelr istl er Einmünung er V. sphen mgn vorgeshlgen, er sih ereits uh in Stuien ewährt ht. For yers, the gret sphenous vein imeter hs een mesure in mny linil stuies investigting vriose vein tretment. This ws lso urge in the onsensus oument of the Interntionl Union of Phleology (UIP) (1). The imeter is mesure t vrious sites long the ourse of the gret sphenous vein ut, unfortuntely, no stnristion hs yet een hieve (2). Furthermore, the imeter of 2 1 Corresponene to Dr. Erik Menoz Vein prtise Wunstorf Spekenstr. 10, D Wunstorf/Germny E-Mil: erik.menoz@t-online.e Phleologie 2014; 43: DOI: Reeive: July 28 th, 2014 Aepte: August 1 st, 2014 Fig. 1 Positioning of the trnsuer uring mesurement of the gret sphenous vein imeter performe with the ptient in the stning position. 1 Exmintion of the sphenofemorl juntion, 2 Exmintion of the gret sphenous vein imeter t the thigh. (With the kin permission of the Springer pulishing ompny, from E. Menoz: Duplex-Sonogrphie er Beinvenen [ exmintion of the leg veins] 2013.) Shttuer 2014 Phleologie 5/2014

2 264 Fous * # + e Fig. 2. (Femle) ptient with isrete gret sphenous vein reflux, gre through the sme groin. The gret sphenous vein imeter is 9.3 mm t this II oring to Hh, n terminl n preterminl vlve inompetene (refluxes point.. Longituinl view through the juntion of the gret sphenous vein not shown here). Trnsverse view through the left groin uring musu- with the ommon femorl vein in the sme ptient (ommon femorl vein lr systole with visulistion of the ommon femorl vein (#) n the entry of not lerly shown in the imge, s it runs t ifferent level, outline inite the gret sphenous vein (*). The lterl segment enters iretly t the sphenofemorl y shing). The outlines flutute, the imeter ppers to vry, mesu- juntion (+) with the ommon juntion of the nterior essory re s 5.6 mm iretly t the juntion n s 8.9 mm further istlly (orresmorl sphenous vein n the femorl ili irumflex vein. The ommon feponing more losely to the mesurement point in imge ). e. Longituinl vein, gret sphenous vein n juntion of the lterl segment re oloure n trnsverse view of the gret sphenous vein 15 m istl to the groin in lue, initing n orthogre flow. The puenl vein joins meilly, the sme ptient with mesurement in the trnsverse view (5.3 mm). In the tking tortuous ourse. At the left ege of the uplex olour ox, segment longituinl view (left), it is ler tht no further flututions in imeter our of this vein is visile s seprte lue re n s re pixel in the juntion t this level of the gret sphenous vein n tht the venous wlls run re (rrows).. Trnsverse view through the sme groin, immeitely istl prllel to eh other n to the skin, so tht mesurement error ue to Phleologie to the juntion 5/2014 shown in imge, without olour uplex, to reor the imeter. flututions, sultions, urvtures or ngle to the skin is Shttuer unlikely The imeter of the ommon femorl vein is 11.1 mm, the gret s- phenous vein imeter is 7.3 mm.. Visulistion 1 m further istlly

3 265 VSM VFC Fig. 3 Mesurement with neurysmti ilttion of the gret sphenous vein juntion.. Trnsverse view through the right groin with inompetent terminl vlve: Reflux into the gret sphenous vein with neurysmti ilttion (outline of the ommon femorl vein n entry re of the gret sphenous vein inite in lue).. Longituinl view of the gret sphenous vein in the sme ptient with mesurement t the mximum imeter of the juntion re (left hlf of imge: 2.74 mm) n further istlly t the point where oth visulise wlls of the gret sphenous vein strt to run prllel to eh other (right hlf of imge: 7.3 mm), f. imge 2.e.. Trnsverse view through the groin with visulistion of the ommon femorl vein n the gret sphenous vein in the re of the estimte mximum imeter (GSV: 2.95 m, CFV: 1.21 m).. Another trnsverse view through the sme groin with optimistion of pressure n ngle, in orer to hieve the mximum possile imeter of the gret sphenous vein: 30.5 mm the ommon femorl vein ppers to orrelte with the severity of isese n rets to tretment of the gret sphenous vein with reution in imeter (3, 4). Mesuring the imeter will will no longer e one for investigtion ut eome routine in phleology prtie sine the introution of ontrt stipulting preopertive mesurement of the imeter when treting vriose veins with enoluminl therml proeures. The imeter is mesure with the ptient in the stning position n the forefoot pointing in slightly lterl iretion ( Fig. 1). The ultrsoun trnsuer is ple trnsversely. Mesuring in the longituinl view hs not eome stnr prtie, s the vein often oes not follow stright ourse, prtiulrly t the juntion, mking it impossile to sertin tht the imeter hs een mesure t the optiml point. Originlly, the gret sphenous vein imeter ws lwys mesure in the sphenofemorl juntion re. There re mny ntomil ostles here, however, resulting in reltively lrge mrgin for error: The triutries of the sphenofemorl juntion open into the gret sphenous vein, so tht it is sometimes impossile to fin site t whih the shpe is ompletely irulr. The juntion itself tkes the well-known form of ishop s rozier, whih lso mkes it iffiult to fin point t whih the imeter n e mesure vertilly to the ourse of the vein. The vein is lu-shpe n its lrgest imeter is sometimes foun iretly t the juntion, sometimes 2 3 m further Shttuer 2014 Phleologie 5/2014

4 266 Fous # * Fig. 4 Mesurement of the imeter in helthy gret sphenous vein.. Visulistion of the right groin in the trnsverse view with olour uplex uring musulr systole. Juntion of the gret sphenous vein (*) n the ommon femorl vein (#) shown.. Trnsverse view immeitely istl to, to mesure the imeter of the ommon femorl vein (20.6 mm) n gret sphenous vein (7.3 mm) in the juntion re.. Longituinl view of the gret sphenous vein in the juntion re (left) n 15 m istl to the juntion with the eep leg vein (right). In the juntion re, it is pprent tht the onfluene of vrious lterl triutries uses flututions in the venous imeter. Further istlly, it gin runs lmost prllel to the skin, without flututions in imeter, whih is optiml for mesuring the imeter (4.8 mm) (f..). Trnsverse view through the proximl inner sie of the thigh with mesurement of the gret sphenous vein imeter (4.6 mm). istlly ( Fig. 2, Fig. 3, Fig. 4, Fig. 5) Some uthors therefore strte to mesure the imeter t the proximl thigh, where the vein follows stright ourse etween the fsi with hrly ny flututions in imeter, so tht the longituinl ultrsoun view shows tht the venous wlls proximl n istl to the skin oth follow prllel ourse n onstnt irle is pprent in the trnsverse view. In this irle, mesurement of the imeter is lerer. A literture serh stting the imeters in the groin n ompnie y personl letters to ll the uthors onfirme tht hrly ny two working groups mesure the imeter in the groin in the sme wy (2). Furthermore, one stuy showe tht this mesurement point t the proximl thigh lso orreltes more losely to linil prmeters (2). It woul therefore pper to e the more suitle mesurement point. To te, mesurement of the ommon femorl vein imeter in ptients hs not een performe in stnrise mnner. The uthor s own stuy oserve the evelopment of the ommon femorl vein imeter fter sphenous vein surgery (3, 4). It erese signifintly n permnently fter the intervention. It ws mesure immeitely istl to the entry of the gret sphenous vein in the groin. Conflit of interest The uthor sttes tht no onflit of interest exists. Phleologie 5/2014 Shttuer 2014

5 267 Fig. 5. Visulistion of the juntion of the gret sphenous vein in nother leg without reflux into the gret sphenous vein. In the juntion re, prominent vlve usp visile (f. ). The imeter of the ommon femorl vein is 14.3 mm, tht of the gret sphenous vein is 10.3 mm.. Longituinl view of the sme leg s in in the juntion re (left) n further istlly (right). The vlve is using ilttion of the vein with flutution in imeter (9.2 mm), further istlly, the vein gin follows more even ourse (5.0 mm). Ethil guielines All t were ompile in ompline with ntionl legisltion n the urrent Delrtion of Helsinki. An informe onsent ws otine from the ptients. Referenes 1. Colerige-Smith P, Lropoulos N, Prtsh H, Myers K, Niolies A, Cvezzi A. Duplex-Ultrshlluntersuhung er Venen er unteren Extremitäten ei hronisher Veneninsuffizienz* UIP Konsensusokument Teil I: Grunlgen. Phleologie 2006; 35(5): Menoz E, Blättler W, Amsler F. Gret Sphenous Vein Dimeter t the Sphenofemorl Juntion n Proximl Thigh s Prmeters of Venous Disese Clss. Eur J Vs Enovs Surg 2013; 45 (1): Menoz E, Berger V, Zollmnn C, Bomhoff M, Amsler F. Klierreuktion er V. sphen mgn un er V. femorlis ommunis nh CHIVA. Phleologie 2011; 40(2): Menoz E. Klierreuktion er V. sphen mgn un er V. femorlis ommunis nh CHIVA Lngzeitergenisse. Phleologie 2013; 42: Shttuer 2014 Phleologie 5/2014