The incidence of PFO-RLS in patients with varicose veins of the lower extremities

doi:10.16139/j.1007-9610.2024.06.06

Abstract

Abstract:

Objective To study and evaluate the incidence of patent foramen ovale（PFO） and intracardiac right-to-left shunt（RLS）in the patients with varicose veins of the lower extremities. Methods From March 2023 to August 2024, 86 consecutive patients with varicose veins of the lower extremities were admitted to Cixi People’s hospital, and 57 of them who agreed to take foam sclerotherapy were selected for PFO-RLS test. Results Of the 57 patients, a total of 23 patients were positive for PFO with an incidence of 40.4% (95% CI: 27.2%-53.5%) and a total of 22 patients were positive for RLS with an incidence of 38.6% (95% CI: 25.6%-51.6%). The incidence of PFO was higher than the reported incidence in the general population, which is 26%. There were no serious complications such as pulmonary embolism or stroke occurred in all patients after surgery. Conclusions The incidence of PFO-RLS in patients with varicose veins of the lower extremities in this study was higher than that of expected in the general population. Patients with lower extremity varicose veins should be aware of the associated neurological complications when choosing sclerotherapy.

Key words: Varicose vein, Sclerotherapy, Patent foramen ovale(PFO), Right-to-left shunt(RLS)

CLC Number:

R543.6
R541

CEN Qing, TANG Mingjun, ZHU Yuefeng. The incidence of PFO-RLS in patients with varicose veins of the lower extremities[J]. Journal of Surgery Concepts & Practice, 2024, 29(06): 493-497.

Figures/Tables 1

References 18

[1]	FORLEE M V, GROUDEN M, MOORE D J, et al. Stroke after varicose vein foam injection sclerotherapy[J]. J Vasc Surg, 2006, 43(1):162-164. doi: 10.1016/j.jvs.2005.09.032 pmid: 16414404
[2]	KIM M, NIROUMANDPOUR M, POUSTINCHIAN B. Transient ischemic attack after foam sclerotherapy in a woman with a patent foramen ovale[J]. J Am Osteopath Assoc, 2016, 116(5):320-323. doi: 10.7556/jaoa.2016.063 pmid: 27111786
[3]	ABDELHAMID N, FAROOQ S, SARRAJ A. Acute is-chemic stroke in a young woman with no known risk factors[J]. WMJ, 2018, 117(1):42-44.
[4]	HOMMA S, SACCO R L. Patent foramen ovale and stroke[J]. Circulation, 2005, 112(7):1063-1072. pmid: 16103257
[5]	WRIGHT D D, GIBSON K D, BARCLAY J, et al. High prevalence of right-to-left shunt in patients with sympto-matic great saphenous incompetence and varicose veins[J]. J Vasc Surg, 2010, 51(1):104-107.
[6]	GAJO E C, KAVINSKY C J, MURPHY J, et al. The pivotal role of PFO in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations[J]. Eur Heart J Case Rep, 2021, 5(8):ytab228.
[7]	BAHTIRI L, THOMSEN A V, ASHINA M, et al. Migraine aura-like episodes following sclerotherapy for varicose veins of the lower extremities—a systematic review[J]. Headache, 2023, 63(1):40-50.
[8]	DE MAESENEER M G, KAKKOS S K, AHERNE T, et al. Editor's choice - European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs[J]. Eur J Vasc Endovasc Surg, 2022, 63(2):184-267.
[9]	GUEX J J, ALLAERT F A, GILLET J L, et al. Immediate and midterm complications of sclerotherapy: report of a prospective multicenter registry of 12,173 sclerotherapy sessions[J]. Dermatol Surg, 2005, 31(2):123-128.
[10]	Gillet J L, Guedes J M, Guex J J, et al. Side-effects and complications of foam sclerotherapy of the great and small saphenous veins: a controlled multicentre prospective study including 1,025 patients[J]. Phlebology, 2009, 24(3):131-138. doi: 10.1258/phleb.2008.008063 pmid: 19470865
[11]	RABE E, BREU F X, CAVEZZI A, et al. European guidelines for sclerotherapy in chronic venous disorders[J]. Phlebology, 2014, 29(6):338-354. doi: 10.1177/0268355513483280 pmid: 23559590
[12]	GIBSON K, KABNICK L. A multicenter, randomized, placebo-controlled study to evaluate the efficacy and safety of Varithena^® (polidocanol endovenous microfoam 1%) for symptomatic, visible varicose veins with saphenofemoral junction incompetence[J]. Phlebology, 2017, 32(3):185-193.
[13]	REGAN J D, GIBSON K D, RUSH J E, et al. Clinical significance of cerebrovascular gas emboli during polidocanol endovenous ultra-low nitrogen microfoam ablation and correlation with magnetic resonance imaging in patients with right-to-left shunt[J]. J Vasc Surg, 2011, 53(1):131-137. doi: 10.1016/j.jvs.2010.06.179 pmid: 20864303
[14]	中华医学会外科学分会血管外科学组. 硬化剂治疗下肢静脉曲张(中国)专家指导意见(2016)[J]. 中国血管外科杂志(电子版), 2017, 9(1):11-14,26.
	Vascular Surgery Group, Chinese Society of Surgery, Chinese Medical Association. Expert guidance on sclerotherapy for varicose veins of the lower extremities (China) (2016)[J]. Chin J Vasc Surg(Electronic Version), 2017, 9(1):11-14,26.
[15]	中华医学会外科学分会血管外科学组, 中国医师协会血管外科医师分会, 中国医疗保健国际交流促进会血管外科分会, 等. 中国慢性静脉疾病诊断与治疗指南[J]. 中华医学杂志, 2019, 99(39):3047-3061.
	CSSG, CAVS, CPAM, et al. Guidelines for the diagnosis and treatment of chronic venous diseases[J]. Natl Med J China, 2019, 99(39):3047-3061.
[16]	中国微循环学会周围血管疾病专业委员会. 聚桂醇注射液治疗下肢静脉曲张微循环专家共识[J]. 血管与腔内血管外科杂志, 2020, 6(5):377-381.
	Chinese Society of Microcirculation & Professional Committee of Vascular Disease. Expert consensus on lauromacrogol injection in the treatment of microcirculation of varicose vein of lower limb[J]. J Vasc Endovasc Surg, 2020, 6(5):377-381.
[17]	中国微循环学会周围血管疾病专业委员会. 原发性下肢浅静脉曲张诊治专家共识(2021版)[J]. 血管与腔内血管外科杂志, 2021, 7(7):762-772.
	Peripheral Vascular Disease Committee of Chinese Socie-ty of Microcirculation. Expert consensus on the diagnosis and treatment of primary superficial varicose veins of the lower extremity (2021 edition)[J]. J Vasc Endovasc Surg, 2021, 7(7):762-772.
[18]	中国医师协会血管外科医师分会静脉学组. 常见静脉疾病诊治规范(2022年版)[J]. 中华血管外科杂志, 2022, 7(1):12-29.
	Chinese Society of Vascular Surgery, Chinese Medical Doctor Association. Diagnosis and treatment standard of common venous diseases (2022 version)[J]. Chin J Vasc Surg, 2022, 7(1):12-29.

Item	PFO (n=23)	Normality (n=34)	t/χ² value	P value
Gender (male/female)	16/7	22/12	0.146	>0.05
Age（years）	55.57±12.40	57.74±11.56	-0.675	>0.05
Operating time (min)	63.04±7.50	50.29±8.16	5.976	<0.05
Intraoperative blood loss（mL）	70.87±14.67	27.21±11.16	12.103	<0.05
Postoperative complication	2	2	0	>0.05