The Prevalence Rates of Insufficient Anterior Accessory Saphenous Vein Based on Sex

The influence of sex on multiple diseases has been characterized and has grown of importance in the last decades. Worldwide, chronic venous insufficiency (CVI) represents the most frequent vascular disease (estimated prevalence 15–80%) and involves the female sex mainly; the Great Saphenous Vein (GSV) and the Small Saphenous Vein (SSV) are usually the most affected and analysed segments. The varicose networks feed by the Anterior Accessory Saphenous Vein (AASV) territory, instead, still represent a complex and less unknow argument; moreover, their development based on sex has never been investigated. The aim is to determine the sex prevalence of varicose networks fed by reflux of the AASV alone or combined with the GSV or SSV.

Methods:

We scanned by the means of the same Colour Doppler Sonography (CDS) protocol 3000 lower limbs in 1500 consecutive patients affected by CVI. Limbs with normal venous function, incomplete scans or affected by post thrombotic syndrome, pelvic reflux, venous malformation, phlebolymphedema and CEAP clinical class C5-C6 were excluded from the final analysis.

Results:

Overall, 1072 patients, 252 males and 820 females (p< 0.0001), matched for age (female 57±13.5 years old versus male 56±13.9 years old, p=0.692), were scanned for a total of 1956 limbs affected by primary CVD, clinical class C2-C4. As reported in Table I, 80 and 482 patients were affected by varicose networks fed by AASV alone or combined with other saphenous territories, respectively in male and female group (OR 2.03, CI 1.56-2.65, p< 0.0001). The main finding was the significant prevalence of varicose networks fed exclusively by reflux of the AASV in the female group (OR 1.96, CI 1.26-3.06, p=0.001). In addition, the combination of varicose networks with reflux of both AASV and GSV was again strongly prevalent in females (OR 1.84, CI 1.34-2.52, p=0.0002). If the SSV was involved no differences were highlighted between the two groups. On the other hand, GSV and SSV insufficiency alone or combined was significantly prevalent in males (OR 0.49, CI 0.37-0.64, p< 0.0001).

Conclusions:

The Ultrasound analysis of the varicose networks demonstrates a significant involvement of the AASV alone or coupled with the GSV, in the female sex. No significant differences were highlighted when the SSV is also involved. Further studies and subgroups analysis must be performed; they might clarify if our findings are related just to sex or influenced by gender peculiarities.