Diametrical Alterations of the great saphenous vein in
correlation to venous reflux By: Andre Sanchez Presented on:
04/19/12
Slide 2
Glossary/Table of Contents Slide 1-Title Page Slide 2-Glossary
Slide 3-About Me Slide 4- Problem Slide 5-Hypothesis Slide 6-9-
Research Slide 10-Purpose Slide 11-Materials Slide 12-13-Procedure
Slide 14- General Medical Survey Slide 15-16- Experimentation Slide
17-18- Venous Reflux Tests Slide 19-23- Data & Graphs Slide
24-26- Statistical Analysis Slide 27-29- Significant Discoveries
Slide 30-33- Discussion Slide 34- Potential Application Slide 35-36
Bibliography
Slide 3
About Me As I progress in the field of science, I cant help but
feel intrigued. The emotions one undergoes when he or she makes a
substantial difference in a life through scientific applications is
truly unbelievable. Being only a sophomore with a strong thirst for
science, I have had the life-changing opportunity to better
familiarize myself with the field of medicine. With a field so
diverse and vital in our world, I, like any other with a dream,
have been striving to my fullest extent to reach my goals. And with
this in mind, I never gave up. I decided to enroll myself in my
schools medical academy and eventually became the president of my
schools HOSA (Health Occupations Students of America) club. Not
only was I blessed with this opportunity, but I was given the
opportunity to experience a real-life medical occupation as a
part-time employee at a local cardiovascular & vein clinic. All
I had in mind was to give back to those in need. And that I did. I
immediately developed a stronger taste for answers in such a field
and decided to study a complex disease known as venous reflux,
which many individuals suffer from each year. And to this day, I
continue to love science with every new question and every new
discovery.
Slide 4
Problem Do the diametrical alterations of the great saphenous
vein correlate with levels of venous reflux? Does venous reflux
vary with differentiation of general medical measurements including
time of day, age, and gender? Do the diametrical alterations of the
great saphenous vein correlate with levels of venous reflux? Does
venous reflux vary with differentiation of general medical
measurements including time of day, age, and gender? Independent
Variables- General medical characteristics (age, gender, time,
weight, height, blood pressure, leg size, physical activity);
diameter change in relation to venous reflux. Independent
Variables- General medical characteristics (age, gender, time,
weight, height, blood pressure, leg size, physical activity);
diameter change in relation to venous reflux. Dependent Variables-
Diameter change & venous reflux. Dependent Variables- Diameter
change & venous reflux. Control Variables- Human population,
vascular ultrasound machine(Philips HDI 5000), 7.5mHz transducer.
Control Variables- Human population, vascular ultrasound
machine(Philips HDI 5000), 7.5mHz transducer.
Slide 5
Hypotheses If the diametrical alterations of the great
saphenous vein are compared in different age groups, then as age
increases, venous reflux increases. If the diametrical alterations
of the great saphenous vein are compared in different age groups,
then as age increases, venous reflux increases. If general medical
characteristics are compared with levels of venous reflux, then as
BMI, blood pressure, weight, age, leg size, and great saphenous
vein (GSV) diameter size increases, so will the levels of venous
reflux. If general medical characteristics are compared with levels
of venous reflux, then as BMI, blood pressure, weight, age, leg
size, and great saphenous vein (GSV) diameter size increases, so
will the levels of venous reflux. If male and females are compared
with levels of venous reflux, then the females will have the
greater levels of reflux. If male and females are compared with
levels of venous reflux, then the females will have the greater
levels of reflux.
Slide 6
Research Within the lower extremities of the body(legs and
groin area), there lies a complex set of venous junctions and
networks, including the saphenofemoral junction that is home to the
superficial veins of the body; the great saphenous vein and the
small saphenous vein (which braches below it; linking with the
femoral vein). The great saphenous vein (GSV), the longest vein in
the body, stretching from the ankle to the groin region of each
leg, allows blood to reach much of the lower extremities and drains
into the femoral vein; near the lower abdomen and upper thigh
(Hoehn et al 2010). Veins, including the GSV, have the capabilities
to expand and contract throughout the day to control blood flow;
however, when a vein has been stressed it tends to allow back flow
of the blood, commonly known as venous reflux (Society of
Interventional Radiology 2011). Venous reflux within the leg can
lead to venous insufficiency or varicose veins. These varicosities
are leaking veins/valves and do not operate properly due to the
lack valve closure among the veins within the lower extremity.
Slide 7
Research Varicose veins can be cosmetically unappealing for
manly people who have them because they leave a distinct bulge or
coloration due to the vessels being swollen. These insufficient
veins can also be very uncomfortable or painful, which could
ultimately lead to skin ulceration or sores because they hinder the
blood circulation throughout the leg. According to Cleveland Clinic
(2011), each year 500,000 to 600,000 people in the United States
suffer from venous ulcers and ultimately account for 80-90 percent
of all leg ulcers. These skin ulcers or sores can become harmful or
severe if left untreated. According to the Society of
Interventional Radiology (2011), varicose veins affect 1 out of 2
people age 50 and older, and 15 to 25% of all adults. Some
contributing factors include age, family history, gender, and
pregnancy (Society of Interventional Radiology 2011). The GSV is
prone to venous reflux due to the commonalities of venous reflux
occurring in this vessel. Some symptoms associated with venous
insufficiency and varicose veins in the GSV include leg pain and
heaviness, which tend to worsen as the day progresses (Society of
Interventional Radiology 2011). Varicose veins can be cosmetically
unappealing for manly people who have them because they leave a
distinct bulge or coloration due to the vessels being swollen.
These insufficient veins can also be very uncomfortable or painful,
which could ultimately lead to skin ulceration or sores because
they hinder the blood circulation throughout the leg. According to
Cleveland Clinic (2011), each year 500,000 to 600,000 people in the
United States suffer from venous ulcers and ultimately account for
80-90 percent of all leg ulcers. These skin ulcers or sores can
become harmful or severe if left untreated. According to the
Society of Interventional Radiology (2011), varicose veins affect 1
out of 2 people age 50 and older, and 15 to 25% of all adults. Some
contributing factors include age, family history, gender, and
pregnancy (Society of Interventional Radiology 2011). The GSV is
prone to venous reflux due to the commonalities of venous reflux
occurring in this vessel. Some symptoms associated with venous
insufficiency and varicose veins in the GSV include leg pain and
heaviness, which tend to worsen as the day progresses (Society of
Interventional Radiology 2011).
Slide 8
Research According to Weiss et al (2001), the presence of
visible varicose veins is typically not a reliable indicator of the
extent of venous reflux within the leg. This fact is the very
reason why many phlebologists use ultrasound technology to obtain a
more thorough understanding. Venous reflux can be treated in a
variety of manners. Treatment can be anything as simple as a change
in lifestyle to schlerotherapy. Patients also have the choice to
undergo vein stripping or litigation, which may be painful for
patients. Within recent decades, many patients have chosen laser
treatment for venous reflux, which is relatively less painful.
Ultrasound imaging is a pain-free noninvasive medical test that
helps physicians observe blood vessels and other internal organs.
With the advancement of ultrasound technology, one can further
investigate the location of blood vessels, along with their size,
shape and consistency. This process is similar to that of a bats
echolocation; since the area being observed is subjected to sound
waves that allow the medical personnel to take the necessary
measurements.
Slide 9
Research The transducer allows the operator to focus on smaller
regions of the body. The operator can manipulate the transducer to
view a different image of the same area. For example, the
transversal view or horizontal position of the transducer allows
its operator to view a vessel and measure the diameters more
accurately. However, a vertically-elongated position of the
transducer allows the operator to observe the blood flow within the
vessel, which is needed for the venous reflux assessment. The
transducer allows the operator to focus on smaller regions of the
body. The operator can manipulate the transducer to view a
different image of the same area. For example, the transversal view
or horizontal position of the transducer allows its operator to
view a vessel and measure the diameters more accurately. However, a
vertically-elongated position of the transducer allows the operator
to observe the blood flow within the vessel, which is needed for
the venous reflux assessment.
Slide 10
Purpose The purpose of this experiment was to determine what
factors contribute to venous reflux disease to develop a better
understanding upon the concept of this disease. I hope scientists
around the world can use this data to potentially devise an
alternative treatment of venous reflux disease. The purpose of this
experiment was to determine what factors contribute to venous
reflux disease to develop a better understanding upon the concept
of this disease. I hope scientists around the world can use this
data to potentially devise an alternative treatment of venous
reflux disease.
Slide 11
Materials General Medical Survey General Medical Survey Scale
with height grid Scale with height grid Manual Sphygmomanometer
with stethoscope Manual Sphygmomanometer with stethoscope Tape
Measure Tape Measure Philips HDI 5000 Vascular Ultrasound Machine
with corresponding equipment Philips HDI 5000 Vascular Ultrasound
Machine with corresponding equipment SG Hypoallergenic ultrasound
scanning gel SG Hypoallergenic ultrasound scanning gel Ultrasound
Transducer 7.5 MHz Ultrasound Transducer 7.5 MHz A Supervising
Professional A Supervising Professional A human population of both
genders A human population of both genders
Slide 12
Procedure 1. Provide potential subjects informed consent, if
required by IRB. 2. Have a trained professional supervise all
activities and act as an assistant. 3. Complete the necessary
measurements as indicated on the survey; and record (however, allow
supervisor to take blood pressure while having patient stand and be
sure to wipe equipment off between subjects). 4. Have the
participant stand in the upright position, relaxed with bare skin
of legs (from above the knee down to foot) uncovered. 5. Divide
legs in zones (zone 1: the knee, zone 2: mid calf, zone 3: ankle 6.
Apply the ultrasound scanning gel on the ultrasound transducer and
on leg in all three zones. 7. Turn off lights to optimize the
clarity of the lighted monitor screen of the ultrasound machine. 8.
Allow the assistant to place the transducer against the patients
inner leg while you locate great saphenous vein on monitor.
Slide 13
Procedure 9. Freeze image and take the actual measurement of
the diameter of the great saphenous vein in each zone of the leg
and record values on survey. 10. Allow the assistant to perform the
venous reflux test by squeezing the leg just beneath the zone that
is being observed and then letting go. 11. Having the assistant
keep the transducer on that part of leg, observe the monitor for
signs of back flow and record the length of time of reflux. 12.
Wipe patients leg off and allow them to wash off ultrasound
scanning gel. 13. Allow participant to take home survey to record
physical activity of the day (after morning measurements) and then
allow participant to bring the survey back to be used in the
evening measurement. 14. Complete this procedure in the morning and
then again in the evening for each participant on the same day for
both legs.
Slide 14
General Medical Survey
Slide 15
Experimentation GSV Diameter Measurement through Doppler
Ultrasound
Slide 16
Experimentation Pulsated view of GSV-Venous Reflux Test through
Duplex Scanning
Slide 17
Venous Reflux Test This test is known as a color-based venous
reflux test using Doppler ultrasound that shows only the flow of
blood along with the vessel. If you peer closely in the video, you
may be able to locate the great saphenous vein (its the dark oval
within the leg). To locate the GSV, one has to train his/her eye to
find the saphenous fascia, which is the deep, connective tissue
layer surrounding the vein (the whitish entity surrounding the
GSV). To determine if any venous reflux exists, one must observe
the change of color on the monitor; the blue is the initial squeeze
or pressure that the operator does and the following red indicated
a back flow of blood, otherwise known as venous reflux.
Slide 18
Venous Reflux Test This test is known as the pulsated venous
reflux test using duplex scanning since it displays both the vessel
and the pulse or levels of back flow. To complete this examination,
the operator must locate the GSV in a horizontal positioning of the
transducer and then gradually shift into a vertically, elongated
position to stretch the scope of the vessel. The operator must then
shift the angle of the machine to view within the GSV alone. In the
video, the initial feedback is the pressure the operator
administers and then the following spike indicated backflow (if
greater than.5 seconds). So in this case, this patient had about
one second of venous reflux (time it takes for the blood to
return).
Slide 19
Data & Graphs Ankle Circumference Calf I measured the
circumference of each zone of the leg and correlated their size
with that of total venous reflux throughout the day to determine if
there were any significant relationships. As displayed in the
graphs, all 3 regions of the leg display a positive correlation
with venous reflux levels.
Slide 20
Data & Graphs
Slide 21
DATA & GRAPHS
Slide 22
Data & Graph
Slide 23
BMI Systolic Pressure
Slide 24
Statistical Analysis
Slide 25
Slide 26
For this experimentation I used inferential statistics to find
significant result among my data. I used t-tests to compare the
average vein diameters of the morning and evening, z-score to
compare females and males in proportion, and Pearson Product Moment
Correlation coefficient to determine relationships within the
data.
Slide 27
Significant Discoveries Women VS Men with Venous Reflux- Claim:
Females will show greater evidence of venous reflux. Null: Both
males and females will have the same amount of venous reflux.
z=2.309 cv=1.960 Decision: Reject Null Vein Alteration- Claim: The
great saphenous vein diameter will increase throughout the day in
comparison to morning measurements. Null: The great saphenous vein
diameter will remain the same throughout the day. t= 4.960 cv=2.00
Decision: Reject Null Age- Claim: The older participants will have
higher levels of venous reflux. Null: All age groups will have the
same levels of venous reflux. t=4.427 cv=4.303 Decision: Reject
Null
Slide 28
Significant Discoveries Expanded Vessels in Evening &
Venous Reflux- Claim: The expanded vessels in the evening will have
the best relationship between venous reflux. Null: All vessels
throughout the day will have the same amount of venous reflux.
r=.850 cv=.754 Decision: Reject Null Calf Circumference &
Venous Reflux- Claim: Calf size will have the greatest relation to
higher levels of venous reflux. Null: All regions of the leg will
equally have the same amount of venous reflux. r=.779cv=.754
Decision: Reject Null Systolic Pressure & Total Venous Reflux-
Claim: Systolic pressure will have the best relationship between
total venous reflux. Null: Systolic pressure will have no relation
to total venous reflux. r=.808 cv=.754 Decision: Reject Null
Slide 29
Significant Discoveries Height & Venous Reflux in the
Morning- Claim: Height will correlate best to venous reflux in the
morning. Null: Height will correlate to venous reflux equally
throughout the day. r=.768 cv=.754 Decision: Reject Null BMI &
Venous Reflux in the Evening- Claim: BMI will best correlate to
venous reflux in the evening. Null: BMI will correlate to venous
reflux equally throughout the day. r=.765 cv=.754 Decision: Reject
Null Venous Reflux in Morning & Venous Reflux P.M- Claim:
Venous reflux will correlate to levels of venous reflux in the
evening. Null: Venous reflux in the morning will not correlate with
any levels of venous reflux in the evening. t=2.325 cv=2.145
Decision: Reject Null
Slide 30
Discussion The data did support the claim for gender. The data
was collected from 32 participants through ultrasound technology
and duplex scanning. The data was then separated into two
populations for analysis; those with evidence of venous reflux and
those without venous reflux. Eighty-six percent of the population
of venous reflux was female, whereas 14% of the population was
male. There was a significant relationship between the proportion
of males to females of the venous reflux population. Based on this
data, I can conclude that females are more prone to have venous
reflux. The data did support the claim for vein alterations. Of the
32 subjects, the majority of the participants proved to have
altering vein diameters (in expansion) in comparison to that of the
morning diameters. The largest difference was 2.9mm, whereas the
smallest contraction was -.6mm. Based on the data, I can conclude
that compared to the morning diameters, evening diameters are
significantly larger. The data did support the claim for age. Of
the venous reflux population, the older populations had the
greatest levels of venous reflux with the highest average of 1.75
seconds, whereas the youth had the lowest with.5 seconds. There was
a significant relationship between age and reflux. Based on this
data, I can conclude that as age increases, so do the levels of
venous reflux.
Slide 31
Discussion The data did support the claim for expanded vessels
in the evening and total levels of venous reflux. Of the venous
reflux population, the largest vein diameter in the evening was
4.55mm and the highest level of venous reflux was 3.5 seconds.
There was significant relationship between expanded vessels (p.m
diameters) and levels of venous reflux. Based on the data, I can
conclude that expanded vessels correlate with levels of venous
reflux. The data did support the claim for calf circumference and
venous reflux. Of the venous reflux population, the largest calf
circumference was 40.2cm and the largest amount of venous reflux
was 3.5 seconds. There was a significant relationship between calf
size and levels of venous reflux. Based on this data, I can
conclude that calf circumference correlates with levels of venous
reflux.
Slide 32
Discussion The data did support the claim for systolic pressure
and total venous reflux. Of the venous reflux population, the
highest systolic pressure was 142mmHg with venous reflux levels of
3.5 seconds, whereas the lowest was 105mmHg with.5 seconds of
venous reflux. There was a significant relationship between
systolic pressure and venous reflux levels. Based on this data, I
can conclude that blood pressure (systolic pressure) is a
contributing factor of venous reflux. The data did support the
claim for height and venous reflux levels in the morning. Of the
venous reflux population, the tallest height was 180.34cm and the
largest amount of venous reflux in the morning was 1.5 seconds of
back flow. There was a significant relationship between height and
venous reflux levels in the A.M. Based on this data, I can conclude
that height correlates with levels of venous reflux in the
A.M.
Slide 33
Discussion The data did support the claim for BMI and venous
reflux in the evening. Of the venous reflux population, 34.33% was
the greatest BMI with 3.5 seconds of venous reflux. There was a
significant relationship between BMI and venous reflux in the
evening. Based on this data, I can conclude that BMI is a
contributing factor of venous reflux. The data did support the
claim for venous reflux in the morning compared to venous reflux in
the evening. Of the venous reflux population, the largest amount of
venous reflux in the morning was 1.5 seconds, whereas the largest
amount of venous reflux in the evening was 2.5 seconds(solely one
leg). There was a significant comparison between venous reflux in
the morning and higher amounts in the evening. Based on this data,
I can conclude that venous reflux levels typically increase
throughout the day and are greatest in the evening.
Slide 34
Potential Application I hope to use the data I have found to
potentially develop an alternative treatment of venous reflux in
future years (based primarily on stabilizing vein diameter changes,
while permitting the flow of blood without constraint). Also,
scientists can use this information to better understand this
disease in the adolescents, which is relatively rare. I hope to use
the data I have found to potentially develop an alternative
treatment of venous reflux in future years (based primarily on
stabilizing vein diameter changes, while permitting the flow of
blood without constraint). Also, scientists can use this
information to better understand this disease in the adolescents,
which is relatively rare.
Slide 35
Bibliography Bergan, JJB. 2007. The Vein Book. Elsevier
Academic Press. San Diego. 511-513. Cleveland Clinic.2011.Diseases
&Conditions:Lower Extremity (Leg and Foot) Ulcers.
http://my.clevelandclinic.org/heart/disorders/vascular/legfootulcer.aspx.
Accessed: January 8th, 2012 Hoehn, K and EN Marieb.2010.Human
Anatomy & Physiology Eighth Edition. Pearson Education, Inc.
San Francisco, 701, 744 Society for Science & the Public. 2011.
Intel International Science & Engineering Fair. International
Rules and Guidelines 2012. SSP, Washington DC. 3-9, 17-22, 30
Slide 36
Bibliography Society of International Radiology 2011.Varicose
and Venous Insufficiency. http://
www.sirweb.org/patient/varicose-veins/ Accessed: September 15th,
2011 Radiological Society of North America, Inc 2010, March
15.Vascular Ultrasound. http://
www.radiologyinfo.org/eninfo.cfm?pg=vascularus. Accessed: September
15th, 2011 United States. Department of Health and Human Services.
Title 45 Public Welfare: Part 46 Protection of Human Subjects.
Washington DC:Government Printing Office. Washington DC. Weiss, RA
and CF; Feied, and MA; Weiss 2001. Vein diagnosis & treatment:
A comprehensive approach. Mc Graw-Hill Companies, Inc. New York.
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