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The importance of deep venous reflux velocity as a determinant of outcome in patients with combined superficial and deep venous reflux treated with endovenous saphenous ablation.
J Vasc Surg. 2008 Aug; 48(2):400-5; discussion 405-6.JV

Abstract

INTRODUCTION

Twenty to thirty percent of patients with symptomatic chronic venous insufficiency (CVI) are found to have combined superficial and deep venous reflux on duplex testing. It is currently unclear whether endovenous ablation (EVA) of the saphenous vein will result in correction of CVI without addressing the deep venous reflux. In this study, we examined deep venous reflux velocities to determine whether these would predict outcome after endovenous ablation.

METHODS

Patients with symptomatic CVI and both saphenous and deep venous reflux were identified using duplex ultrasonography. Reflux times and maximal reflux velocity (MRV) in each examined vein segment were determined. In each limb, the venous filling index (VFI) and the venous clinical severity score (VCSS) were obtained both before and after laser ablation of the great and/or small saphenous veins. Preoperative venous reflux velocities were correlated with improvement in VFI and VCSS after ablation.

RESULTS

75 limbs with both deep and superficial venous reflux were identified. Seventy-five percent of limbs were CEAP clinical class 3 or 4 and the other 25% were class 5 or 6. Forty limbs demonstrated deep venous reflux in the femoral and/or popliteal vein. After EVA, significant improvements in VFI and VCSS were seen, but this depended on MRV in the deep vein. When MRV in the popliteal or femoral vein was <10 cm/sec, limbs had significantly better outcomes than limbs with MRV >10 cm/sec as measured by both VFI (P = .01) and VCSS (P = .03). In 35 limbs, deep venous reflux was identified only in the CFV. In this group, the average pre-procedure VFI (6.54 +/- 3.9 cc/sec) decreased significantly to 2.2 +/- 1.9 cc/sec (P < .001) and the VCSS improved markedly from 7.0 +/- 2.8 to 1.3 +/- 1.4 (P < .001).

CONCLUSIONS

EVA of the saphenous veins can be performed in patients with concomitant deep venous insufficiency with hemodynamic and clinical improvement in most cases. Patients with popliteal or femoral reflux velocities lower than 10 cm/sec usually experience marked improvement in both the VFI and the VCSS. Patients with femoral or popliteal reflux velocities greater than 10 cm/sec have a high incidence of persistent symptoms after EVA.

Authors+Show Affiliations

Division of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18644484

Citation

Marston, William A., et al. "The Importance of Deep Venous Reflux Velocity as a Determinant of Outcome in Patients With Combined Superficial and Deep Venous Reflux Treated With Endovenous Saphenous Ablation." Journal of Vascular Surgery, vol. 48, no. 2, 2008, pp. 400-5; discussion 405-6.
Marston WA, Brabham VW, Mendes R, et al. The importance of deep venous reflux velocity as a determinant of outcome in patients with combined superficial and deep venous reflux treated with endovenous saphenous ablation. J Vasc Surg. 2008;48(2):400-5; discussion 405-6.
Marston, W. A., Brabham, V. W., Mendes, R., Berndt, D., Weiner, M., & Keagy, B. (2008). The importance of deep venous reflux velocity as a determinant of outcome in patients with combined superficial and deep venous reflux treated with endovenous saphenous ablation. Journal of Vascular Surgery, 48(2), 400-5; discussion 405-6. https://doi.org/10.1016/j.jvs.2008.03.039
Marston WA, et al. The Importance of Deep Venous Reflux Velocity as a Determinant of Outcome in Patients With Combined Superficial and Deep Venous Reflux Treated With Endovenous Saphenous Ablation. J Vasc Surg. 2008;48(2):400-5; discussion 405-6. PubMed PMID: 18644484.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The importance of deep venous reflux velocity as a determinant of outcome in patients with combined superficial and deep venous reflux treated with endovenous saphenous ablation. AU - Marston,William A, AU - Brabham,V Wells, AU - Mendes,Robert, AU - Berndt,Daniel, AU - Weiner,Meredith, AU - Keagy,Blair, PY - 2008/01/29/received PY - 2008/03/15/revised PY - 2008/03/17/accepted PY - 2008/7/23/pubmed PY - 2008/8/23/medline PY - 2008/7/23/entrez SP - 400-5; discussion 405-6 JF - Journal of vascular surgery JO - J Vasc Surg VL - 48 IS - 2 N2 - INTRODUCTION: Twenty to thirty percent of patients with symptomatic chronic venous insufficiency (CVI) are found to have combined superficial and deep venous reflux on duplex testing. It is currently unclear whether endovenous ablation (EVA) of the saphenous vein will result in correction of CVI without addressing the deep venous reflux. In this study, we examined deep venous reflux velocities to determine whether these would predict outcome after endovenous ablation. METHODS: Patients with symptomatic CVI and both saphenous and deep venous reflux were identified using duplex ultrasonography. Reflux times and maximal reflux velocity (MRV) in each examined vein segment were determined. In each limb, the venous filling index (VFI) and the venous clinical severity score (VCSS) were obtained both before and after laser ablation of the great and/or small saphenous veins. Preoperative venous reflux velocities were correlated with improvement in VFI and VCSS after ablation. RESULTS: 75 limbs with both deep and superficial venous reflux were identified. Seventy-five percent of limbs were CEAP clinical class 3 or 4 and the other 25% were class 5 or 6. Forty limbs demonstrated deep venous reflux in the femoral and/or popliteal vein. After EVA, significant improvements in VFI and VCSS were seen, but this depended on MRV in the deep vein. When MRV in the popliteal or femoral vein was <10 cm/sec, limbs had significantly better outcomes than limbs with MRV >10 cm/sec as measured by both VFI (P = .01) and VCSS (P = .03). In 35 limbs, deep venous reflux was identified only in the CFV. In this group, the average pre-procedure VFI (6.54 +/- 3.9 cc/sec) decreased significantly to 2.2 +/- 1.9 cc/sec (P < .001) and the VCSS improved markedly from 7.0 +/- 2.8 to 1.3 +/- 1.4 (P < .001). CONCLUSIONS: EVA of the saphenous veins can be performed in patients with concomitant deep venous insufficiency with hemodynamic and clinical improvement in most cases. Patients with popliteal or femoral reflux velocities lower than 10 cm/sec usually experience marked improvement in both the VFI and the VCSS. Patients with femoral or popliteal reflux velocities greater than 10 cm/sec have a high incidence of persistent symptoms after EVA. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/18644484/The_importance_of_deep_venous_reflux_velocity_as_a_determinant_of_outcome_in_patients_with_combined_superficial_and_deep_venous_reflux_treated_with_endovenous_saphenous_ablation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(08)00475-8 DB - PRIME DP - Unbound Medicine ER -