Chronic venous disease: Correlation between ultrasound findings and the clinical, etiologic, anatomic and pathophysiologic classification.

Objective: The aim of the study was to investigate association between clinical manifestation of chronic venous disease and the presence and severity of functional venous disease.

Method: A cross-sectional study was conducted in 14 towns in Serbia. All men and women aged >18 years, consecutively coming to venous specialists (47 specialists) were included in the study. Patients who were previously treated for chronic venous disease were excluded. Patients were classified according to the clinical category of clinical, etiologic, anatomic and pathophysiologic classification for chronic venous disease. Reflux and/or obstruction were determined by using a color duplex ultrasound.

Results: The study included 1679 chronic venous disease patients. Color duplex ultrasound was performed in 1029 (61.3%) of them who formed the final study group. Reflux was found in 76.8% of patients - 53.1% had reflux in superficial, 7.2% in deep and 16.1% in perforator veins. Obstruction was found in 31.9% of patients - superficial in 14.8% of patients and deep in 16.9%. Deep obstruction was even found in clinical, etiologic, anatomic and pathophysiologic C0s-C1 categories. Reflux and obstruction combined were revealed in 19.1% of patients. Reflux in deep and perforator veins and reflux and obstruction combined were significantly associated with clinical, etiologic, anatomic and pathophysiologic clinical categories being the most frequent in patients with venous ulcers.

Conclusion: Clinical, etiologic, anatomic and pathophysiologic clinical categories of chronic venous disease are strongly correlated with functional disease especially with reflux in deep and perforator veins, and reflux and obstruction combined. The presence of deep obstruction in patients with chronic venous disease belonging to clinical, etiologic, anatomic and pathophysiologic C0s-C1 category could justify recommendation for color duplex ultrasonography in all patients with symptoms of chronic venous disease but without clear clinical signs.