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[Correlation between clinical-instrumental pattern in venous pathology (capillaroscopic classification of the medial
1Cattedra e Scuola di Specializzazione in Chirurgia Vascolare, Ospedale Garibaldi, Università degli Studi, Catania.
Insights
Capillaroscopy is the most sensitive method for diagnosing venous diseases, accurately correlating symptoms with instrumental findings. This technique identified pathological alterations even when Doppler ultrasound yielded normal results.
Area of Science:
- Vascular Medicine
- Phlebology
- Diagnostic Imaging
Background:
- Chronic venous insufficiency is prevalent, often presenting discrepancies between patient symptoms and Doppler ultrasound results.
- Sensitive instrumental methods are crucial for accurate diagnosis in venous diseases.
- Current diagnostic approaches require enhancement to reliably link clinical presentation with objective findings.
Purpose of the Study:
- To evaluate the sensitivity of various instrumental methods used in phlebology outpatient departments.
- To determine the most effective method for establishing a correlation between clinical symptoms and instrumental patterns in venous diseases.
Main Methods:
- Fifty-one subjects (44 with venous disease, 7 healthy) were studied.
- Methods included clinical examination, Widmer criteria classification, Doppler ultrasound (c.w.), infrared photoplethysmography, and medial malleolus capillaroscopy.
Main Results:
- Capillaroscopy exhibited the highest sensitivity in detecting pathological alterations.
- It identified abnormalities in symptomatic patients with normal Doppler c.w. findings.
- Pathological venular networks were observed in healthy subjects' malleoli.
Conclusions:
- Capillaroscopy is superior for diagnosing venous disease when Doppler ultrasound is inconclusive.
- A modified, five-step capillaroscopy classification, including sub-classes for reticular patterns, is proposed.
- This enhanced classification effectively relates venule gauge to patient-reported symptoms.
Background:
The high incidence of chronic venous insufficiency makes it quite an ordinary topic in the outpatients departments of vascular units. Furthermore, due to the discrepancy between symptoms and Doppler c.w reports, it is necessary to face this problem with the help of very sensitive instrumental methods. Therefore, the main aim of this article is to find out which method, among those used in the outpatients department of phlebology, is sensitive enough to establish a relationship between clinical and instrumental patterns in venous diseases.
Methods:
Fifty-one subjects were studied: 44 affected by venous disease and 7 healthy subjects. All patients underwent clinical examination followed by classification by Widmer criteria, Doppler c.w., infrared photoplethysmography and capillaroscopy of the medial malleolus.
Results And Conclusions:
Capillaroscopy demonstrated to have the highest sensitivity, allowing to find out pathological alterations in subjects complaining of symptoms and with normal Doppler c.w. findings. Furthermore, the findings of venular networks (pathological) in the malleoli of healthy subjects, made it necessary to modify the current capillaroscopic classification (based upon three types of pictures: normal, reticular and halo formations), into a new extended version based on five steps, with three types of reticular sub-classes, in which the different gauge of the venules is satisfactorily related to the symptoms referred by the patients.