Abstract

Backgrounds: Chronic venous insufficiency (CVI) is a condition of the venous wall and/or valves’ dysfunction in the leg veins prone to venous thrombosis and reducing quality of life. This study sought to find risk factors of CVI and develop a dedicated risk score model to predict the presence of chronic venous insufficiency in patients who experience leg edema Methods: In a total of 1,226 patients (age 65.2± 15.0, 662 women) with leg swelling, specialized protocols for venous function tests were applied for diagnosis of CVI in a single center vascular ultrasound laboratory from Mar 2015 to Dec 2020 after exclusion of the presence of deep vein thrombosis. Duplex ultrasound scan on the greater and lesser saphenous veins was performed with patients erect or as upright as possible. Using a tilt table, patients’ position was flexibly changed. For the distal augmentation to assess for venous incompetence, we used the Hokanson ® E20 Rapid Cuff Inflator. Pathologic reflux is defined by reversal of flow greater than 500 milliseconds in duration. The new CVI scoring system was calculated from logistic regression model. The VEIN-score were compared with cardiovascular risk scoring system established for other purposes. Results: 607 patients (49.5%) were diagnosed with CVI. The final risk score ranged from 0 to 6 points and included six parameters: age ≥ 65 years, male sex, obesity (body mass index ≥ 25 kg/m 2 ), hypertension, atrial fibrillation, and a history of myocardial infarction, which were derived from the results of logistic regression model ( Figure A ). The incidence of CVI gradually increased from 39% to 100%, as the score increased from 0 up to 6 points ( Figure B ). The new scoring system showed modest predictive value (C-index: 0.575, 95% CI: 0.544-0.606, cut-off value 3), higher than the CHA 2 DS 2 -VASc score and H 2 FPEF score. Conclusions: Old age, male sex, obesity, history of atrial fibrillation and myocardial infarction were significant risk factors for CVI. We propose VEIN-SCORE as a dedicated risk score model to predict chronic venous insufficiency in patients with leg swelling.