Truncal venous insufficiency I83.9

Hach W 1977

The term "truncal venous insufficiency" is a term introduced by the phlebologist W. Hach in 1977 and is based on the pathophysiological concept of reflux-induced recirculation and the resulting venous hypertension. In principle, this concept of varicosis is still valid today. Here, the upper and lower insufficiency point of a truncal vein plays a decisive role.

Upper point of insufficiency: The upper point of insufficiency is the most proximal point of the truncal vein at which an insufficient transfascial communication (perforating vein) can be detected.

Complete truncal venous insufficiency: If the proximal point of insufficiency is located in the magna or para-saphenous orifice, this pathological condition is called "complete truncal venous insufficiency".

Incomplete truncal venous insufficiency: In incomplete truncal venous insufficiency the proximal point of insufficiency is not in the magna or parva saphenous orifice but distal to it.

Lower insufficiency point: The lower insufficiency point is the distal point of the truncal vein with a still sufficient venous valve. Here a lateral branch varice opens into the truncal vein and drains the hypertonic reflux area (see also recirculation according to Hach).

Score for graduation of truncal venous insufficiency: A score for graduation of the severity of truncal varicosis introduced by W. Hach et al. in 1997 is still a proven practice today:

Magna saphenous vein

• Grade 1: Insufficiency of the muzzle valves
• Grade 2: Insufficiency of the venous valves with retrograde blood flow to above the knee
• Grade 3: Insufficiency of the venous valves with retrograde blood flow to below the knee
• Grade 4: Insufficiency of the venous valves with retrograde blood flow to the ankle region

saphenous vein

• Grade 1: Insufficiency of the muzzle valves
• Grade 2: Insufficiency of the venous valves with retrograde blood flow to the middle of the calf
• Grade 3: Insufficiency of the venous valves with retrograde blood flow to the ankle region

1. Hach W et al (1977) Classification of the trunk varicosis of V. saphena magna into four stages. Phleb u proctol 6: 16-23
2. Nüllen H et al (2010) Classifications, stadiums, graduations and scores. In: T Noppeney, H Nüllen Diagnosis and therapy of varicosis. Springer Medicine Publishing House Heidelberg S 130 -138