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Prevalence of deep venous reflux in patients with primary superficial vein incompetence.
J Vasc Surg 2000; 32(4):663-8JV

Abstract

PURPOSE

This prospective study was designed to determine the prevalence of deep reflux and the conditions under which it may occur in patients with primary superficial venous reflux and absence of deep venous thrombosis (DVT).

METHODS

We studied 152 limbs in 120 consecutive patients in the standing position who had superficial venous reflux with color flow duplex scanning. Limbs with documented evidence of DVT or post-thrombotic vein wall changes during the examination were studied but not included in the analysis. Limbs were divided into those that had at least reflux in the saphenofemoral, the saphenopopliteal, or the gastropopliteal junction and into those with nonjunctional reflux in the superficial and gastrocnemial veins. Peak velocity and duration of reflux were measured. To examine the recirculation theory, we tested the deep veins by occluding and refluxing saphenous veins 10 cm below the sampling site.

RESULTS

Thirteen limbs in 11 patients (9%) were excluded because of previous DVT. Of the remaining 139 limbs, 106 (76%) had junctional reflux. Saphenofemoral junction was involved in 89 limbs (84%), saphenopopliteal junction in 18 (17%), and gastropopliteal junction in 7 (4%). In 33 limbs (24%), reflux was detected in the main trunk or tributaries of the saphenous veins alone with no junctional incompetence. Femoral or popliteal reflux was present in 31 limbs (22%). This reflux was segmental in 27 limbs, and it was limited in the junction in 24 limbs. The mean duration of deep venous reflux was 0.9 seconds, it ranged from 0.6 to 3.7 seconds, and it was significantly shorter than that in the superficial veins (2.6 seconds; P <.0001). In the absence of junctional reflux, the prevalence of deep venous insufficiency (DVI) was significantly lower compared with that in limbs with junctional involvement (2 of 33 vs 29 of 106; P =.038). The mean duration of deep venous reflux in these groups was comparable (0.85 seconds vs 0. 91 seconds; P =.44). Occlusion of the incompetent superficial veins reduced somewhat the duration of the deep venous reflux but did not abolish it (0.88 seconds vs 0.82 seconds; P =.072). The presence of DVI was associated with junctional reflux of high peak velocity and long duration.

CONCLUSIONS

The prevalence of DVI in patients with primary superficial venous reflux and without history of DVT is 22%. However, this reflux is segmental, mainly in the common femoral vein, and is of short duration. It is associated with the presence of junctional incompetence that has a high peak velocity and long duration. These findings may explain why surgical correction of superficial reflux abolishes DVI.

Authors+Show Affiliations

Division of Vascular Surgery, Loyola University Medical Center, Maywood, IL 60153-3304, USA. nlabrop@luc.edu

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11013028

Citation

Labropoulos, N, et al. "Prevalence of Deep Venous Reflux in Patients With Primary Superficial Vein Incompetence." Journal of Vascular Surgery, vol. 32, no. 4, 2000, pp. 663-8.
Labropoulos N, Tassiopoulos AK, Kang SS, et al. Prevalence of deep venous reflux in patients with primary superficial vein incompetence. J Vasc Surg. 2000;32(4):663-8.
Labropoulos, N., Tassiopoulos, A. K., Kang, S. S., Mansour, M. A., Littooy, F. N., & Baker, W. H. (2000). Prevalence of deep venous reflux in patients with primary superficial vein incompetence. Journal of Vascular Surgery, 32(4), pp. 663-8.
Labropoulos N, et al. Prevalence of Deep Venous Reflux in Patients With Primary Superficial Vein Incompetence. J Vasc Surg. 2000;32(4):663-8. PubMed PMID: 11013028.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of deep venous reflux in patients with primary superficial vein incompetence. AU - Labropoulos,N, AU - Tassiopoulos,A K, AU - Kang,S S, AU - Mansour,M A, AU - Littooy,F N, AU - Baker,W H, PY - 2000/9/30/pubmed PY - 2001/2/28/medline PY - 2000/9/30/entrez SP - 663 EP - 8 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 32 IS - 4 N2 - PURPOSE: This prospective study was designed to determine the prevalence of deep reflux and the conditions under which it may occur in patients with primary superficial venous reflux and absence of deep venous thrombosis (DVT). METHODS: We studied 152 limbs in 120 consecutive patients in the standing position who had superficial venous reflux with color flow duplex scanning. Limbs with documented evidence of DVT or post-thrombotic vein wall changes during the examination were studied but not included in the analysis. Limbs were divided into those that had at least reflux in the saphenofemoral, the saphenopopliteal, or the gastropopliteal junction and into those with nonjunctional reflux in the superficial and gastrocnemial veins. Peak velocity and duration of reflux were measured. To examine the recirculation theory, we tested the deep veins by occluding and refluxing saphenous veins 10 cm below the sampling site. RESULTS: Thirteen limbs in 11 patients (9%) were excluded because of previous DVT. Of the remaining 139 limbs, 106 (76%) had junctional reflux. Saphenofemoral junction was involved in 89 limbs (84%), saphenopopliteal junction in 18 (17%), and gastropopliteal junction in 7 (4%). In 33 limbs (24%), reflux was detected in the main trunk or tributaries of the saphenous veins alone with no junctional incompetence. Femoral or popliteal reflux was present in 31 limbs (22%). This reflux was segmental in 27 limbs, and it was limited in the junction in 24 limbs. The mean duration of deep venous reflux was 0.9 seconds, it ranged from 0.6 to 3.7 seconds, and it was significantly shorter than that in the superficial veins (2.6 seconds; P <.0001). In the absence of junctional reflux, the prevalence of deep venous insufficiency (DVI) was significantly lower compared with that in limbs with junctional involvement (2 of 33 vs 29 of 106; P =.038). The mean duration of deep venous reflux in these groups was comparable (0.85 seconds vs 0. 91 seconds; P =.44). Occlusion of the incompetent superficial veins reduced somewhat the duration of the deep venous reflux but did not abolish it (0.88 seconds vs 0.82 seconds; P =.072). The presence of DVI was associated with junctional reflux of high peak velocity and long duration. CONCLUSIONS: The prevalence of DVI in patients with primary superficial venous reflux and without history of DVT is 22%. However, this reflux is segmental, mainly in the common femoral vein, and is of short duration. It is associated with the presence of junctional incompetence that has a high peak velocity and long duration. These findings may explain why surgical correction of superficial reflux abolishes DVI. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/11013028/Prevalence_of_deep_venous_reflux_in_patients_with_primary_superficial_vein_incompetence_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(00)86329-6 DB - PRIME DP - Unbound Medicine ER -