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

## TL;DR

This study explores how lymph node varicose veins in the groin are linked to chronic venous disease and how they affect tissue stiffness using ultrasound.

## Contribution

The study introduces a new perspective on chronic venous disease by identifying and analyzing intranodal varicose veins and their impact on lymph node stiffness.

## Key findings

- Over 83% of operated CVD patients had lymph node varicose veins.
- Lymph node varicose veins correlate with lower stiffness (SWE values) and larger lymph node diameters.
- Elastographic values are significantly influenced by varicose vein severity and lymph node size.

## Abstract

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.