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Deep axial reflux, an important contributor to skin changes or ulcer in chronic venous disease.

Abstract

OBJECTIVE

We undertook this cross-sectional study to investigate the distribution of venous reflux and effect of axial reflux in superficial and deep veins and to determine the clinical value of quantifying peak reverse flow velocity and reflux time in limbs with chronic venous disease.

PATIENTS AND METHODS

Four hundred one legs (127 with skin changes, 274 without skin changes) in 272 patients were examined with duplex ultrasound scanning, and peak reverse flow velocity and reflux time were measured. Both parameters were graded on a scale of 0 to 4. The sum of reverse flow scores was calculated from seven venous segments, three in superficial veins (great saphenous vein at saphenofemoral junction, great saphenous vein below knee, small saphenous vein) and four in deep veins (common femoral vein, femoral vein, deep femoral vein, popliteal vein). Axial reflux was defined as reflux in the great saphenous vein above and below the knee or in the femoral vein to the popliteal vein below the knee. Reflux parameters and presence or absence of axial reflux in superficial or deep veins were correlated with prevalence of skin changes or ulcer (CEAP class 4-6).

RESULTS

The most common anatomic presentation was incompetence in all three systems (superficial, deep, perforator; 46%) or in superficial or perforator veins (28%). Isolated reflux in one system only was rare (15%; superficial, 28 legs; deep, 14 legs; perforator, 18 legs). Deep venous incompetence was present in 244 legs (61%). If common femoral vein reflux was excluded, prevalence of deep venous incompetence was 52%. The cause, according to findings at duplex ultrasound scanning, was primary in 302 legs (75%) and secondary in 99 legs (25%). Presence of axial deep venous reflux increased significantly with prevalence of skin changes or ulcer (C4-C6; odds ratio [OR], 2.7; 95% confidence interval [CI], 1.56-4.67). Of 110 extremities with incompetent popliteal vein, 81 legs had even femoral vein reflux, with significantly more skin changes or ulcer, compared with 29 legs with popliteal reflux alone (P =.025). Legs with skin changes or ulcer had significantly higher total peak reverse flow velocity (P =.006), but the difference for total reflux time did not reach significance (P =.084) compared with legs without skin changes. In contrast, presence of axial reflux in superficial veins did not increase prevalence of skin changes (OR, 0.73; 95% CI, 0.44-1.2). Incompetent perforator veins were observed as often in patients with no skin changes (C0-C3, 215 of 274, 78%) as in patients with skin changes (C4-C6, 106 of 127, 83%; P =.25).

CONCLUSION

Continuous axial deep venous reflux is a major contributor to increased prevalence of skin changes or ulcer in patients with chronic venous disease compared with segmental deep venous reflux above or below the knee only. The total peak reverse flow velocity score is significantly higher in patients with skin changes or ulcer. It is questionable whether peak reverse flow velocity and reflux time can be used to quantify venous reflux; however, if they are used, peak reverse flow velocity seems to reflect venous malfunction more appropriately.

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  • Authors+Show Affiliations

    ,

    Straub Foundation and John A. Burns School of Medicine, Department of Medicine, University of Hawaii, Honolulu, Hawaii, USA. gudmundurdanielsson@yahoo.com

    , , ,

    Source

    Journal of vascular surgery 38:6 2003 Dec pg 1336-41

    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Blood Flow Velocity
    Chronic Disease
    Cross-Sectional Studies
    Female
    Humans
    Leg
    Leg Ulcer
    Male
    Middle Aged
    Time Factors
    Ultrasonography
    Veins
    Venous Insufficiency

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    14681638

    Citation

    Danielsson, Gudmundur, et al. "Deep Axial Reflux, an Important Contributor to Skin Changes or Ulcer in Chronic Venous Disease." Journal of Vascular Surgery, vol. 38, no. 6, 2003, pp. 1336-41.
    Danielsson G, Eklof B, Grandinetti A, et al. Deep axial reflux, an important contributor to skin changes or ulcer in chronic venous disease. J Vasc Surg. 2003;38(6):1336-41.
    Danielsson, G., Eklof, B., Grandinetti, A., Lurie, F., & Kistner, R. L. (2003). Deep axial reflux, an important contributor to skin changes or ulcer in chronic venous disease. Journal of Vascular Surgery, 38(6), pp. 1336-41.
    Danielsson G, et al. Deep Axial Reflux, an Important Contributor to Skin Changes or Ulcer in Chronic Venous Disease. J Vasc Surg. 2003;38(6):1336-41. PubMed PMID: 14681638.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Deep axial reflux, an important contributor to skin changes or ulcer in chronic venous disease. AU - Danielsson,Gudmundur, AU - Eklof,Bo, AU - Grandinetti,Andrew, AU - Lurie,Fedor, AU - Kistner,Robert L, PY - 2003/12/19/pubmed PY - 2004/1/14/medline PY - 2003/12/19/entrez SP - 1336 EP - 41 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 38 IS - 6 N2 - OBJECTIVE: We undertook this cross-sectional study to investigate the distribution of venous reflux and effect of axial reflux in superficial and deep veins and to determine the clinical value of quantifying peak reverse flow velocity and reflux time in limbs with chronic venous disease. PATIENTS AND METHODS: Four hundred one legs (127 with skin changes, 274 without skin changes) in 272 patients were examined with duplex ultrasound scanning, and peak reverse flow velocity and reflux time were measured. Both parameters were graded on a scale of 0 to 4. The sum of reverse flow scores was calculated from seven venous segments, three in superficial veins (great saphenous vein at saphenofemoral junction, great saphenous vein below knee, small saphenous vein) and four in deep veins (common femoral vein, femoral vein, deep femoral vein, popliteal vein). Axial reflux was defined as reflux in the great saphenous vein above and below the knee or in the femoral vein to the popliteal vein below the knee. Reflux parameters and presence or absence of axial reflux in superficial or deep veins were correlated with prevalence of skin changes or ulcer (CEAP class 4-6). RESULTS: The most common anatomic presentation was incompetence in all three systems (superficial, deep, perforator; 46%) or in superficial or perforator veins (28%). Isolated reflux in one system only was rare (15%; superficial, 28 legs; deep, 14 legs; perforator, 18 legs). Deep venous incompetence was present in 244 legs (61%). If common femoral vein reflux was excluded, prevalence of deep venous incompetence was 52%. The cause, according to findings at duplex ultrasound scanning, was primary in 302 legs (75%) and secondary in 99 legs (25%). Presence of axial deep venous reflux increased significantly with prevalence of skin changes or ulcer (C4-C6; odds ratio [OR], 2.7; 95% confidence interval [CI], 1.56-4.67). Of 110 extremities with incompetent popliteal vein, 81 legs had even femoral vein reflux, with significantly more skin changes or ulcer, compared with 29 legs with popliteal reflux alone (P =.025). Legs with skin changes or ulcer had significantly higher total peak reverse flow velocity (P =.006), but the difference for total reflux time did not reach significance (P =.084) compared with legs without skin changes. In contrast, presence of axial reflux in superficial veins did not increase prevalence of skin changes (OR, 0.73; 95% CI, 0.44-1.2). Incompetent perforator veins were observed as often in patients with no skin changes (C0-C3, 215 of 274, 78%) as in patients with skin changes (C4-C6, 106 of 127, 83%; P =.25). CONCLUSION: Continuous axial deep venous reflux is a major contributor to increased prevalence of skin changes or ulcer in patients with chronic venous disease compared with segmental deep venous reflux above or below the knee only. The total peak reverse flow velocity score is significantly higher in patients with skin changes or ulcer. It is questionable whether peak reverse flow velocity and reflux time can be used to quantify venous reflux; however, if they are used, peak reverse flow velocity seems to reflect venous malfunction more appropriately. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/14681638/Deep_axial_reflux_an_important_contributor_to_skin_changes_or_ulcer_in_chronic_venous_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741521403009078 DB - PRIME DP - Unbound Medicine ER -