A Study of Chronic Venous Insufficiency in Relation with Body Mass Index and Diameter of Saphenofemoral Junction and Great Saphenous Vein
Authors: Patel Jayesh , Shah Pratiksha , Gandhi Fenil 
Published: February 2021

Introduction:
Chronic venous insufficiency (CVI) is a condition that occurs when the venous wall and/or valves in the lower limb veins are not functioning effectively, making it difficult for the blood to return to the heart from the lower limb. Over time, it can lead to pain, swelling, skin changes over the lower limb, and ulcers around the ankles. Some common etiological factors of CVI include obesity, more than 50 years of age, family history of CVI, smoking, and pregnancy. The combination of obesity and other genetic and environmental factors creates a higher risk for the development of CVI.

Objective:
The objective was to study the relation between body mass index (BMI) and CVI at its various stages using the clinical, etiological, anatomical, and pathophysiologic (CEAP) classification of CVI. In addition, it was to study whether there was a notable increase of diameter seen in saphenofemoral junction and great saphenous vein (GSV) as the BMI increases and in patients of CVI.

Materials and Methods:
It was a study conducted on 100 consecutive patients; data were collected from the vascular surgery outpatient department where patients presented with venous disease. The grade of the venous disease was recorded using the CEAP criteria. BMI was calculated for each patient. Based on the BMI, the patients were classified into underweight, normal, overweight, and obese. The mean, standard deviation,Pvalue, and percentage of each stage of venous disease in each group were calculated accordingly and studied.

Results:
A total of 100 patients were undertaken for the study, out of which 78 were male and 22 were female. The clinical stage according to the CEAP criteria, BMI, diameter of the saphenofemoral junction, and diameter of the GSV was recorded for each patient. Clinical stage (CEAP criteria) was discovered to become more advanced as the BMI increased. According to the data, 50% of underweight patients reported of CVI, 53% of normal weight patients reported of CVI, 72% of overweight patients reported of CVI, and 87% of obese patients reported of CVI. Furthermore, it was noted that there was an increase in the diameter of the GSV as the BMI increased, although no change was seen in the diameter of the saphenofemoral junction.

Conclusion:
Lower limb venous flow parameters differ significantly among normal, overweight, and obese individuals. The CEAP clinical stage of venous disease is more advanced in obese patients than in nonobese patients with comparable anatomical patterns of venous incompetence. This could possibly be a result of raised intra-abdominal pressure leading to greater reflux, increased vein diameter, and venous pressures. In addition, an increase in diameter was noted in the GSV, however no change in diameter was observed at the saphenofemoral junction, as the BMI of the patients increased. Hence, the findings support the mechanical role of abdominal adipose tissue, which may potentially lead to elevated risk for both, venous thromboembolism and CVI.