A New Pearl in Chronic Venous Disease Pathophysiology-The Duplex Ultrasound and the Elastographic Features of Lymph Nodes Varicose Veins in the Groin.

Background/

Objectives

Chronic venous disease (CVD) is a prevalent condition marked by valve dysfunction and increased pressure in lower limb veins. The trans-nodal veins in the inguinal region and Scarpa triangle, which connect the superficial and deep venous systems, provide new insight into venous insufficiency pathways. While they function normally in healthy individuals, they can become dilated in chronic venous disease or following surgery. The purpose of this study was to provide an ultrasonographic anatomical description of intranodal varicose veins and to assess possible changes in the stiffness of varicose, dilated inguinal lymph nodes.

Methods

The study comprised 92 participants, including 69 women and 23 men, who underwent Doppler ultrasound examinations of the lower-limb venous system, focusing on the groin from both a descriptive morphological and an elastographic perspective. The diagnosis of lymph node varices was made according to established criteria, its severity was assessed using an original classification system, and shear-wave elastography (SWE) values were recorded.

Results

More than 83% of patients with operated CVD had lymph node varicose veins. Patients with lymph node varicose veins had larger groin lymph node diameters than patients with CVD without lymph node varicose pathology. The mean shear wave elastography values were significantly lower in the group with lymph node varices compared to the group without (12.2 ± 1.1 kPa vs. 20.1 ± 2.3 kPa; p < 0.05). Elastographic values correlate with lymph node diameter (p = 0.039) and with varicose vein grade (p < 0.001).

Conclusions

Intranodal varices may indicate disease progression. These vascular abnormalities impact SWE measurements by altering tissue mechanics. It is imperative to consider the interactions between the lymphatic and venous systems in the management of CVD to improve patient outcomes.