Evaluating the Comparative Accuracy of Posture-Specific Measurements of Vein Diameters (GSV and SSV) in Chronic Venous Insufficiency

Abstract

Background:Chronic venous insufficiency (CVI) represents a significant global health burden, with a prevalence ranging between 25-33% in adult populations. Duplex ultrasonography serves as the cornerstone for diagnosing CVI, yet substantial variability exists in measurement protocols, particularly regarding patient positioning. The physiological effects of hydrostatic pressure in upright positions significantly increase venous dilation compared to supine measurements, potentially impacting diagnostic accuracy and correlation with clinical disease severity.

Materials and Methods: This comprehensive review synthesizes evidence from clinical studies investigating the relationship between great saphenous vein (GSV) and small saphenous vein (SSV) diameters measured in different positional orientations (supine, standing, reverse Trendelenburg) and their correlation with venous reflux and CEAP (Clinical, Etiological, Anatomical, Pathophysiological) clinical classification. Analysis of diagnostic cutoff values, receiver operating characteristic (ROC) curves, and methodological considerations for posture-specific imaging protocols are examined.

Conclusion :Evidence consistently demonstrates that standing-position measurements yield significantly larger venous diameters compared to supine positioning, with mean differences of 19-24% in saphenous trunk diameter between positions. Standing measurements exhibit stronger correlation with clinical CEAP classification and improved diagnostic accuracy for detecting pathological reflux. The optimal cutoff diameter for predicting GSV reflux ranges from 5.05-5.88 mm in standing positions, compared to 3.55-5.29 mm for SSV reflux. Standardization of posture during venous duplex ultrasonography is essential for accurate diagnosis, with standing positioning recommended for optimal correlation with clinical disease severity.