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Hemodynamics of the sapheno-femoral junction. Patterns of reflux and their clinical implications.
Int Angiol. 2004 Mar; 23(1):25-8.IA

Abstract

AIM

The detection of reflux elicited by the compression/release test with the PW Doppler sample at the level of the sapheno-femoral arch might not be sufficient by itself to diagnose the incompetence of the whole sapheno-femoral junction (SFJ). The aim of this study was to further refine the diagnosis by positioning the PW Doppler sample at different levels of SFJ and eliciting reflux both by squeezing and with the Valsalva manoeuvre. In addition, the relationship of the findings with the vein diameter was taken into consideration.

METHODS

By using a high resolution duplex scanner, 1 294 great saphenous veins (GSV) found to be incompetent by the compression/release test at duplex investigation of the saphenous arch, were also tested at the same level by the Valsalva manoeuvre. Subsequently, the tests were repeated by positioning the PW Doppler sample at the femoral side of the terminal valve, at the saphenous arch tributaries, and at the pre-terminal valve level. Furthermore, the GSV diameter in the standing position was measured at 15 cm from the groin in all patients, and correlated with the hemodynamic patterns found at the junction level.

RESULTS

Comparing to compression/release test at the level of the saphenous arch, the Valsalva manoeuvre was negative in 259 (20%) lower limbs and positive in 1 035 (80%). Among the 1 294 GSV found to be incompetent at compression/release test at the level of the saphenous arch, only 710 (55%) lower limbs showed incompetence of the terminal valve. A total of 124 patients (10%), presenting with a competent terminal valve but with a positive Valsalva manoeuvre in the arch, showed a downward flow from a pelvic tributary of the GSV. Finally, a significant statistical correlation between the presence of a competent terminal valve and a GSV diameter <5 mm has been found (p<0.001).

CONCLUSION

Our data show that the detection of reflux elicited by compression/release test at the level of the saphenous arch is insufficient to diagnose the incompetence of the terminal valve. Our results, together with the correlation between the saphenous trunk diameter at the thigh and the competence or the incompetence of the terminal valve, present significant clinical implications when sapheno-femoral surgical disconnection is contemplated.

Authors+Show Affiliations

Don Gnocchi Foundation, Florence, Italy.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15156126

Citation

Cappelli, M, et al. "Hemodynamics of the Sapheno-femoral Junction. Patterns of Reflux and Their Clinical Implications." International Angiology : a Journal of the International Union of Angiology, vol. 23, no. 1, 2004, pp. 25-8.
Cappelli M, Molino Lova R, Ermini S, et al. Hemodynamics of the sapheno-femoral junction. Patterns of reflux and their clinical implications. Int Angiol. 2004;23(1):25-8.
Cappelli, M., Molino Lova, R., Ermini, S., & Zamboni, P. (2004). Hemodynamics of the sapheno-femoral junction. Patterns of reflux and their clinical implications. International Angiology : a Journal of the International Union of Angiology, 23(1), 25-8.
Cappelli M, et al. Hemodynamics of the Sapheno-femoral Junction. Patterns of Reflux and Their Clinical Implications. Int Angiol. 2004;23(1):25-8. PubMed PMID: 15156126.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemodynamics of the sapheno-femoral junction. Patterns of reflux and their clinical implications. AU - Cappelli,M, AU - Molino Lova,R, AU - Ermini,S, AU - Zamboni,P, PY - 2004/5/25/pubmed PY - 2005/1/6/medline PY - 2004/5/25/entrez SP - 25 EP - 8 JF - International angiology : a journal of the International Union of Angiology JO - Int Angiol VL - 23 IS - 1 N2 - AIM: The detection of reflux elicited by the compression/release test with the PW Doppler sample at the level of the sapheno-femoral arch might not be sufficient by itself to diagnose the incompetence of the whole sapheno-femoral junction (SFJ). The aim of this study was to further refine the diagnosis by positioning the PW Doppler sample at different levels of SFJ and eliciting reflux both by squeezing and with the Valsalva manoeuvre. In addition, the relationship of the findings with the vein diameter was taken into consideration. METHODS: By using a high resolution duplex scanner, 1 294 great saphenous veins (GSV) found to be incompetent by the compression/release test at duplex investigation of the saphenous arch, were also tested at the same level by the Valsalva manoeuvre. Subsequently, the tests were repeated by positioning the PW Doppler sample at the femoral side of the terminal valve, at the saphenous arch tributaries, and at the pre-terminal valve level. Furthermore, the GSV diameter in the standing position was measured at 15 cm from the groin in all patients, and correlated with the hemodynamic patterns found at the junction level. RESULTS: Comparing to compression/release test at the level of the saphenous arch, the Valsalva manoeuvre was negative in 259 (20%) lower limbs and positive in 1 035 (80%). Among the 1 294 GSV found to be incompetent at compression/release test at the level of the saphenous arch, only 710 (55%) lower limbs showed incompetence of the terminal valve. A total of 124 patients (10%), presenting with a competent terminal valve but with a positive Valsalva manoeuvre in the arch, showed a downward flow from a pelvic tributary of the GSV. Finally, a significant statistical correlation between the presence of a competent terminal valve and a GSV diameter <5 mm has been found (p<0.001). CONCLUSION: Our data show that the detection of reflux elicited by compression/release test at the level of the saphenous arch is insufficient to diagnose the incompetence of the terminal valve. Our results, together with the correlation between the saphenous trunk diameter at the thigh and the competence or the incompetence of the terminal valve, present significant clinical implications when sapheno-femoral surgical disconnection is contemplated. SN - 0392-9590 UR - https://www.unboundmedicine.com/medline/citation/15156126/Hemodynamics_of_the_sapheno_femoral_junction__Patterns_of_reflux_and_their_clinical_implications_ L2 - http://www.minervamedica.it/index2.t?show=R34Y2004N04A0025 DB - PRIME DP - Unbound Medicine ER -