Thermography and varicose veins.

One of the most striking applications of thermography is for the detection of problems in the circulation and vascular system of the human body.

The application of thermography to support diagnosis is a recurring theme due to the relationship of temperature with the different tissues of the human body and its response to pathology, in this case it is related to venous return problems as vericose veins.

Pathological processes affect the musculoskeletal system or the central nervous system. In this case, we will see how thermography can help assess problems in the circulatory system and how the affectations of the vascular system, which at first sight are not striking, when we perform thermography, they can appear clearly marked.

In addition, these affectations, as a rule, are usually unilateral, therefore knowing and identifying them must be a priority. With this, we will avoid making an error of interpretation due to the influence factors and individualize based on the profile of each athlete or patient.

Venous system: problems in the blood return

In this entry, we will investigate the effects of the venous blood system, which, unlike the arterial system, deals with the return circulation and is characterized by the increase in temperature of that section due to the difficulty in its transport.

The analogy that we describe from ThermoHuman refers to a pond or a bathtub in those areas with a worse venous return. The blood stagnates and the temperature of that circuit increases, which results in the pattern we will see below. (Figure 1)

Figure 1. Venous return problem in the lateral region of the leg (A) without thermal scale contrast (B) applying a higher contrast to see the route.

A discovery that remains to be confirmed but has some logic is that athletes with worse venous return suffer more muscular problems. This could be due to poorer muscle oxygenation or increased regional waste material. However, more research is needed in this regard.

Varicose veins as the main venous return problem

The detection of varicose veins by thermography is not a new application, there is research from 1964 by Rosenberg et al. where they described how the course of the varicose veins had more temperature measured through a contact thermometer. (Figure 2)

Figure 2. Contact thermometers were used in the research by Rosenberg et al (1964).

As early as 2012, different communications were made (Martins et al 2012) on the usefulness of thermography before and after surgery for venous insufficiency, and how it can help in follow-up after a surgical procedure. In all of them the response was hyperthermic prior to the operation and then a normalized temperature after surgery. (Figure 3)

Figure 3. Surgical removal process for the varicose veins.

In 2017 Cholewka et al (2017) investigated the use of isotherms to identify problems related to venous insufficiency. In this study, very strong correlations (r = 0.86; p < 0.0001) were found between mean leg temperature and the percentage of the area of the region that was above the marked isotherm in the mean values for those patients with venous insufficiency. If the average temperature of my legs is 31ºC and I have a percentage greater than 50% of areas in the legs above that average, I have a greater risk of venous insufficiency. (Figure 4)

Figure 4. Calculation of the percentage of areas above the mean isotherm (Cholewka, A et al 2017)

Finally, Dahlmanns, S et al (2021) related the thermal patterns with the stages of the varicose processes to be able to identify them early, even before they were visible in the normal spectrum, and thus be able to act to avoid more advanced stages. of varicose veins that could ulcerate. (Figure 5)

Figure 5. Different stages of evolution of a varicose vein problem. (Dahlmanns, S et al 2021)

Therefore, with current technology, thermography is a method of identifying varicose veins and venous return problems with high specificity. In addition, it allows venous insufficiency to be categorized into stages based on the route, temperature, and location.

Other problems associated with venous return

Less common problems such as thrombophlebitis or an arteriovenous shunt or even an infection will also have a hyperthermic pattern in the form of a marked road in the affected areas. (Figure 6)

Figure 6. (A) Handball player where the throwing arm has a hyperthermic sign of previous thrombophlebitis (B) Arteriovenous shunt in a patient.

Cases of varicose veins in athletes

From ThermoHuman we present some cases of athletes that we have analyzed where the presence of varicose veins and problems in venous return are observed that are not perceptible to the human eye but leave a striking pattern in the thermographic analysis.

The most significant thing is when analyzing with the software how these varicose veins are going to influence the asymmetries. Figure 7 shows the first evaluation of a soccer player where his avatar will be influenced by the different varicose veins that he presents. We can observe how the left adductor, the posterior region of the thigh and in the left calf, show asymmetries of more than 1.5ºC difference. Something that from ThermoHuman we treat as pathological and that if they are not individualized they can give rise to errors.

Figure 7. Session report of a player with varicose veins and the influence on asymmetry avatars

Finally, to rescue from the thesis of Fernández-Cuevas et al. (2012) the mention of this same paradigm in professional athletes from different disciplines. (Figure 8).

Figure 8. Different athletes with venous return problems (Fernández-Cuevas 2012)

References

Rosenberg, N., & Stefanides, A. (1964). Thermography in the management of varicose veins and venous insufficiency. Annals of the New York Academy of Sciences, 121(1), 113-117.

Martins, M., Ribeiro, L. F., & Cury, J. (2012). Diagnostic evaluation of chronic venous insufficiency cases using thermal imaging. In 12th European Congress of Thermology (Vol. 22, pp. 169-176). European Association of Thermology and Austrian Society of Thermology.

Cholewka, A., Kajewska, J., Marek, K., Sieroń-Stołtny, K., & Stanek, A. (2017). How to use thermal imaging in venous insufficiency?. Journal of Thermal Analysis and Calorimetry, 130, 1317-1326

Dahlmanns, S., Reich-Schupke, S., Schollemann, F., Stücker, M., Leonhardt, S., & Teichmann, D. (2021). Classification of chronic venous diseases based on skin temperature patterns. Physiological Measurement, 42(4), 045001.

Fernández Cuevas, Ismael (2012). Effect of endurance, speed and strength training on skin temperature measured by infrared thermography = Efecto del entrenamiento de resistencia, velocidad y fuerza en la temperatura de la piel a través de la termografía infrarroja. Tesis (Doctoral), Facultad de Ciencias de la Actividad Física y del Deporte (INEF) (UPM). https://doi.org/10.20868/UPM.thesis.14896.