Correlation of day-period, clinical evaluation and duplex in varicose veins. A cross-sectional study in an upper-middle income country of South America




Oral session: Global health and equity (2)


Wednesday 23 October 2019 - 11:00 to 12:30


All authors in correct order:

Cavalieri E1, Barros E1, Freitas T1, Trevizo J1, César C1, Amaral F1, Cassola N1, Prestes O1, Clezar C1, Guedes L1, Flumignan C1, Vasconcelos V1, Nakano L1, Guedes H1, Amorim J1, Baptista-Silva J1, Flumignan R1
1 Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, Brazil
Presenting author and contact person

Presenting author:

Ettore Cavalieri

Contact person:

Abstract text
Background: chronic venous disease (CVD) is defined as a dysfunction of the venous system caused by valve incompetence. It is a public health problem given its high prevalence (87%) and its complications. The worsening of symptoms and signals in the afternoon period or after extended time in an erect position is known. However, it is still not established whether there is an influence of similar factors in the venous vascular ultrasound (venous duplex).

Objectives: to correlate the clinical and epidemiological data of idiopathic varicose veins patients with the time of venous duplex.

Methods: this is a cross-sectional study of all patients with a surgical indication for varicose veins of lower limbs and who underwent related lower limb venous duplex in 2017 in a single centre in Brazil. Additional data such as clinical, etiological, anatomic, pathophysiological (CEAP) classification and epidemiological information were also collected from electronic records. Participants with no clinical history of varicose veins, with other vascular diseases and repeated examinations of the same patient, were not relevant.

All venous duplex was evaluated at least with B-mode and spectral analysis in longitudinal vessel view. The criteria used for pathological veins were the presence of reflux in the femoral and popliteal segment by a time greater than 1 second, superficial reflux and other deeps greater than 0.5 seconds and reflux in perforating veins greater than 0.35 seconds.

Results: we included 358 participants with venous duplex performed in 2017. From these, 139 (108 women) had the duplex performed in the morning (between 08:00 and 11:59 am, inclusive) and 219 (167 women) in the afternoon (between 12:00 and 06:00 pm, inclusive). Of these, 57 had a normal duplex, 51 had superficial vein reflux and 31 had more than one alteration in superficial, deep or perforator veins. In afternoon duplex, 71 were normal, 85 presented superficial reflux and 63 presented more than one alteration.

CEAP C2 was the most prevalent clinical presentation in 122 exams (103 women), C3 in 74 exams (59 women) and we had 15 participants without CEAP description. In both sexes, the more common complaints were pain and lower limb oedema. In this specific sample population of an upper-middle-income country, men are more asymptomatic and complain more about oedema, while women complain more about pain.

Conclusions: in our population, there was more pathological venous duplex in the afternoon period (68%) compared to the morning period (59%). Varicose veins were less prevalent in men but with more severe cases (CEAP C6).

Patient or healthcare consumer involvement: the public health system in Brazil, the setting of our results, is more used by a low-income population. The correlation of the period of the ultrasound examination and clinical and epidemiological aspects of people with varicose veins may improve clinical decision making and avoid the waste of health resources.