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Patterns of saphenous reflux in women with primary varicose veins.

Abstract

OBJECTIVE

Varicose veins have been linked to great saphenous vein (GSV) reflux and in particular, with reflux at the saphenofemoral junction (SFJ). Early stages of disease, however, may be associated with limited, localized reflux in segments of the GSV and/or small saphenous vein (SSV). Ultrasound mapping of saphenous veins was performed to determine patterns of GSV and SSV reflux in women with simple, primary varicose veins.

METHODS

Ultrasound mapping was performed prospectively in 590 extremities of 326 women with varicose veins (CEAP C 2 class) but without edema, skin changes, or ulcers (C 3 to C 6 ). Average age was 42 +/- 13 (SD) years (range, 8 to 87). Patterns of GSV and SSV reflux, obtained in the upright position, were classified as I: perijunctional, originating from the SFJ or saphenopopliteal junction (SPJ) tributaries into the GSV or SSV; II: proximal, from the SFJ or SPJ to a tributary or perforating vein above the level of the malleoli; III: distal, from a tributary or perforating vein to the paramalleolar GSV or SSV; IV: segmental, from a tributary or perforating vein to another tributary or perforating vein above the malleoli; V; multisegmental, if two or more distinct refluxing segments were detected; and VI: diffused, involving the entire GSV or SSV from the SFJ or SPJ to the malleoli.

RESULTS

Reflux was detected in 472 extremities (80%): 100 (17%) had reflux in both the GSV and SSV, 353 (60%) had GSV reflux only, and 19 (3%) had SSV reflux only, for a total prevalence of 77% at the GSV and 20% at the SSV. The most common pattern of GSV reflux was segmental (types IV and V) in 342 (58%) of 590; either one segment in 213 (36%) or more than one segment with competent SFJ in 99 (17%), or incompetent SFJ in 30 (5%), followed by distal GSV reflux (type III) in 65 (11%), proximal GSV reflux (type II) in 32 (5%), diffused throughout the entire GSV (type VI) in 10 (2%), and perijunctional (type I) in 4 (<1%). GSV refluxing segments were noted in the SFJ in 72 (12%) and in the thigh in 220 (37%), and leg (or both) in 345 (58%).

CONCLUSIONS

The high prevalence of reflux justifies ultrasound mapping of the saphenous veins in women with primary varicose veins. Correction of SFJ reflux, however, may be needed in <or=12% of the extremities, and only about one third CEAP C2 limbs may require treatment of a refluxing GSV in the thigh.

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  • Authors+Show Affiliations

    ,

    Santa Casa de Misericordia, Pontificia Universidade Catolica do Paraná, Brazil.

    , ,

    Source

    Journal of vascular surgery 41:4 2005 Apr pg 645-51

    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Child
    Female
    Humans
    Middle Aged
    Popliteal Vein
    Prospective Studies
    Regional Blood Flow
    Saphenous Vein
    Ultrasonography, Doppler, Color
    Varicose Veins
    Venous Insufficiency

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    15874929

    Citation

    Engelhorn, Carlos Alberto, et al. "Patterns of Saphenous Reflux in Women With Primary Varicose Veins." Journal of Vascular Surgery, vol. 41, no. 4, 2005, pp. 645-51.
    Engelhorn CA, Engelhorn AL, Cassou MF, et al. Patterns of saphenous reflux in women with primary varicose veins. J Vasc Surg. 2005;41(4):645-51.
    Engelhorn, C. A., Engelhorn, A. L., Cassou, M. F., & Salles-Cunha, S. X. (2005). Patterns of saphenous reflux in women with primary varicose veins. Journal of Vascular Surgery, 41(4), pp. 645-51.
    Engelhorn CA, et al. Patterns of Saphenous Reflux in Women With Primary Varicose Veins. J Vasc Surg. 2005;41(4):645-51. PubMed PMID: 15874929.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Patterns of saphenous reflux in women with primary varicose veins. AU - Engelhorn,Carlos Alberto, AU - Engelhorn,Ana Luiza V, AU - Cassou,Maria Fernanda, AU - Salles-Cunha,Sergio X, PY - 2005/5/6/pubmed PY - 2005/5/25/medline PY - 2005/5/6/entrez SP - 645 EP - 51 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 41 IS - 4 N2 - OBJECTIVE: Varicose veins have been linked to great saphenous vein (GSV) reflux and in particular, with reflux at the saphenofemoral junction (SFJ). Early stages of disease, however, may be associated with limited, localized reflux in segments of the GSV and/or small saphenous vein (SSV). Ultrasound mapping of saphenous veins was performed to determine patterns of GSV and SSV reflux in women with simple, primary varicose veins. METHODS: Ultrasound mapping was performed prospectively in 590 extremities of 326 women with varicose veins (CEAP C 2 class) but without edema, skin changes, or ulcers (C 3 to C 6 ). Average age was 42 +/- 13 (SD) years (range, 8 to 87). Patterns of GSV and SSV reflux, obtained in the upright position, were classified as I: perijunctional, originating from the SFJ or saphenopopliteal junction (SPJ) tributaries into the GSV or SSV; II: proximal, from the SFJ or SPJ to a tributary or perforating vein above the level of the malleoli; III: distal, from a tributary or perforating vein to the paramalleolar GSV or SSV; IV: segmental, from a tributary or perforating vein to another tributary or perforating vein above the malleoli; V; multisegmental, if two or more distinct refluxing segments were detected; and VI: diffused, involving the entire GSV or SSV from the SFJ or SPJ to the malleoli. RESULTS: Reflux was detected in 472 extremities (80%): 100 (17%) had reflux in both the GSV and SSV, 353 (60%) had GSV reflux only, and 19 (3%) had SSV reflux only, for a total prevalence of 77% at the GSV and 20% at the SSV. The most common pattern of GSV reflux was segmental (types IV and V) in 342 (58%) of 590; either one segment in 213 (36%) or more than one segment with competent SFJ in 99 (17%), or incompetent SFJ in 30 (5%), followed by distal GSV reflux (type III) in 65 (11%), proximal GSV reflux (type II) in 32 (5%), diffused throughout the entire GSV (type VI) in 10 (2%), and perijunctional (type I) in 4 (<1%). GSV refluxing segments were noted in the SFJ in 72 (12%) and in the thigh in 220 (37%), and leg (or both) in 345 (58%). CONCLUSIONS: The high prevalence of reflux justifies ultrasound mapping of the saphenous veins in women with primary varicose veins. Correction of SFJ reflux, however, may be needed in <or=12% of the extremities, and only about one third CEAP C2 limbs may require treatment of a refluxing GSV in the thigh. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/15874929/Patterns_of_saphenous_reflux_in_women_with_primary_varicose_veins_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741521405001023 DB - PRIME DP - Unbound Medicine ER -