By: Lowell S. Kabnick, MD, FACS Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.

1. Division of Vascular and Endovascular Surgery
Lowell S. Kabnick, MD, FACS
Does Multiple Axial Vein
Incompetence Increase
The Clinical Severity Of
Venous Disease?

2. Division of Vascular and Endovascular Surgery
Disclosure
.
I do not have any potential conflict of
interest

3. Patterns of saphenous reflux in
women with primary veins
 590 limbs(326 women) C2 class
 Reflux 80%
 GSV and SSV 17%
GSV 60%
 SSV 20%
Nonsaphenous 20%
Englehorn; JVS 2005;41-645-51

4. Division of Vascular and Endovascular Surgery
LOWELL S. KABNICK, MD
HAMZA RANA, MD
Clinical Severity and Number of
Superficial Axial Veins with Reflux in
Each Lower Extremeity

5. Division of Vascular and Endovascular Surgery
Study Aim:
To evaluate the association between clinical
severity of primary varicose veins and
number of superficial axial veins with
reflux for each leg

6. Division of Vascular and Endovascular Surgery
Study Design
•Single Center, Retrospective
•Patients:
•>18 yr- seen at NYU Langone Medical Center Vein
Center -November 2012 and February 2013 with baseline
data available for CEAP clinical class, VCSS, and
Venous DUS.
•Excluded were:
•Patients <18 year of age
•History of previous lower extremity superficial venous
intervention
•Deep venous thrombosis.

7. Division of Vascular and Endovascular Surgery
Predictor Variable:
•Clinical classification of CEAP
•Revised Venous Clinical Severity Score
Outcome Variable:
•Number of axial superficial veins with reflux on
venous duplex ultrasound
•Duration of reflux > 0.5 seconds
•GSV, SSV, AASV, PASV saphenous vein,
intersaphenous vein (Vein of Giacomini), and cranial
extension of small saphenous vein
•Relevant Covariates:
•Age, sex, BMI, number of pregnancies

8. Division of Vascular and Endovascular Surgery
RESULTS

9. Patient Characteristics
Variable Total
(SD,%)
N=150
Males
(SD,%)
N=39
Females
(SD,%)
N=111
P
Value
Age , Years ± SD 52.81±14.9 52.82±16.6 52.80±14.4 0.99
BMI, kg/m2 22.89±3.4 29.37±7.9 24. 56±5.7 <.005
Family Hx of
Varicose Veins
103 (77.4%) 18 (54.5%) 85(85%) <.005
Mother 61(49.6%) 9(31%) 52(55.3%) <.005
Father 29(23.6%) 6(20.7%) 23(24.5%) 0.67
Grandparents 18(14.6%) 1(3.4%) 17(18.1%) 0.04
Hx of Superficial
Phlebitis
11(7.3%) 4(10.3%) 7(6.3%) 0.31
Deep Vein Reflux 16(10.7%) 5 (12.8%) 11(9.9%) 0.40
VCSS,Median(range) 4(0-25) 5(0-25) 3(0-13) NS

10. Division of Vascular and Endovascular Surgery
CEAP Clinical Categories
63% ≥ C-3

11. Division of Vascular and Endovascular Surgery
Number of Superficial Axial Veins
with Reflux
10.7%
83/150 ≥1 superficial Axial veins
reflux (55.3%)

12. Superficial Vein
with Reflux
Total
(%)
Males
(%)
Females
(%)
P
Value
GSV 72 (48%) 24 (61.5%) 48 (43.2%) 0.04
SSV 17 (11.3%) 4 (10.3%) 13 (11.7%) 0.53
AASV 8 (5.3%) 4 (10.3%) 4 (3.6%) 0.12
Giacomini 3 (2.6%) 0 (0%) 3(2.7%) 0.40
Cranial Extension of
SSV
0 0 0 --
Posterior ASV 0 0 0 --
GSV+ SSV 10 (6.6%) 3(7.6%) 8(7.2%) NS
GSV + AASV 3 (2.0%) 3(7.6%) 0 --
GSV + Giacomini 1 (0.7%) 0 1(0.9%) --
SSV+ Giacomini 3 (2.0%) 0 3(2.7%) --
GSV+ SSV+
Giacomini
1 (0.7%) 0 1(0.9%) --

13. Division of Vascular and Endovascular Surgery
CEAP Category & Superficial
Refluxing Veins
Cochran-Armitage Trend Test for
CEAP Categories <0.0001
There is a trend towards multiple superficial veins with
worsening CEAP class with P value of <.0001

14. Division of Vascular and Endovascular Surgery
Correlation Between Number Of
Refluxing Superficial Axial Veins And
Clinical Variables
Variable Number of Superficial
Veins with Reflux r Value
P Value
VCSS 0.43 0.01
CEAP 0.56 0.01
Age -0.04 0.56
BMI 0.09 0.23
Pearson and Spearman Coefficient (r values) Correlation
>0.5 strong
0.3-0.5 moderate

15. Univariate Logistic Regression Analysis
Variable Multiple Superficial
Axial Veins (≥2)
Odds Ratio
95% CI OR P Value
CEAP Category
CEAP C 0-2
CEAP C 3-6
0.09 0.01 0.72 0.02
11.11
VCSS 1.11 1.00 1.23 .06
Gender
Female 0.54 0.18 1.61 0.27
Age 0.99 0.96 1.03 0.81
BMI 1.03 0.95 1.12 0.40

16. Multivariate Logistic Regression Analysis
Variable Multiple Superficial
Axial Veins(≥2)
Odds Ratio
95% CI OR P Value
CEAP Category
CEAP C 0-2
CEAP C 3-6
0.10 0.01 0.88 0.03
10
VCSS 1.04 0.90 1.20 0.56
Female Vs Male 1.24 0.28 5.55 0.77
Pregnancy ≤2 Vs > 2 0.99 0.22 4.48 0.97
Age 0.99 0.95 1.03 0.79
BMI 1.01 0.92 1.13 0.72
No Interaction between
Gender, CEAP or VCSS
C 3-6 is Independent predictor for multiple superficial veins

17. Conclusions
 Multiple superficial Axial veins with reflux in the
lower extremity are present in 11% of Patients
 Advanced CEAP Clinical Class is an independent
predictor for multiple superficial Axial Veins with
reflux (Odds Ratio of 10 for Multiple Superficial
Axial Vein)
 Revised VCSS was not statistically significant
independent predictor for multiple superficial
Axial Veins with reflux.