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Duplex ultrasonography scanning for chronic venous disease: patterns of venous reflux.

Abstract

PURPOSE

Patterns of flow in superficial and deep veins and outward flow in medial calf perforators were studied by duplex ultrasonography scanning in 1653 lower limbs in 1114 consecutive patients. This study compares results in 776 limbs with primary uncomplicated varicose veins with those in 166 limbs with the complications of lipodermatosclerosis or past venous ulceration.

METHODS

Duplex scanning determined whether superficial and deep veins were occluded or showed reflux and whether outward flow occurred in medial calf perforators with calf muscle contraction.

RESULTS

Two proximal deep veins were occluded. When limbs with primary uncomplicated varicose veins, lipodermatosclerosis, or past ulceration were compared, superficial reflux alone was seen in 55%, 39%, and 38%, deep reflux alone was seen in 2%, 7%, and 8%, and combined superficial and deep reflux was seen in 18%, 34%, and 48%, respectively. Superficial reflux affected the long saphenous system alone in 58%, 57%, and 40%, the short saphenous system alone in 18%, 18%, and 26%, and both the long and short saphenous systems in 24%, 25%, and 34%, respectively. Limbs with ulceration more frequently showed superficial reflux (p < 0.05), and all limbs with complications more frequently showed short saphenous reflux (p < 0.05) and deep reflux (p < 0.01) specifically in the posterior tibial veins (p < 0.01). Outward flow was seen in medial calf perforators in 57%, 67%, and 66%, respectively; it occurred more frequently in all limbs with complications (p < 0.05). Isolated outward flow in perforators without superficial or deep reflux was seen in 10%, 10%, and 2%, respectively.

CONCLUSIONS

Most limbs with complications had superficial reflux either alone or combined with deep reflux, and few had deep reflux alone. Reflux was more frequent in posterior tibial veins for limbs with complications compared with those with uncomplicated primary varicose veins. Outward flow in perforators was common in limbs with complications and with uncomplicated primary varicose veins, but isolated outward flow in perforators was uncommon. Treatment directed to the superficial veins alone may be sufficient for most patients with complications.

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  • Authors+Show Affiliations

    ,

    Department of Surgery, Monash University, Monash Medical Centre, Melbourne, Australia.

    , ,

    Source

    Journal of vascular surgery 21:4 1995 Apr pg 605-12

    MeSH

    Chronic Disease
    Femoral Vein
    Humans
    Leg
    Muscle Contraction
    Muscle, Skeletal
    Popliteal Vein
    Prospective Studies
    Regional Blood Flow
    Saphenous Vein
    Scleroderma, Localized
    Tibia
    Ultrasonography, Doppler, Duplex
    Varicose Ulcer
    Varicose Veins
    Vascular Patency
    Veins

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    7707565

    Citation

    Myers, K A., et al. "Duplex Ultrasonography Scanning for Chronic Venous Disease: Patterns of Venous Reflux." Journal of Vascular Surgery, vol. 21, no. 4, 1995, pp. 605-12.
    Myers KA, Ziegenbein RW, Zeng GH, et al. Duplex ultrasonography scanning for chronic venous disease: patterns of venous reflux. J Vasc Surg. 1995;21(4):605-12.
    Myers, K. A., Ziegenbein, R. W., Zeng, G. H., & Matthews, P. G. (1995). Duplex ultrasonography scanning for chronic venous disease: patterns of venous reflux. Journal of Vascular Surgery, 21(4), pp. 605-12.
    Myers KA, et al. Duplex Ultrasonography Scanning for Chronic Venous Disease: Patterns of Venous Reflux. J Vasc Surg. 1995;21(4):605-12. PubMed PMID: 7707565.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Duplex ultrasonography scanning for chronic venous disease: patterns of venous reflux. AU - Myers,K A, AU - Ziegenbein,R W, AU - Zeng,G H, AU - Matthews,P G, PY - 1995/4/1/pubmed PY - 1995/4/1/medline PY - 1995/4/1/entrez SP - 605 EP - 12 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 21 IS - 4 N2 - PURPOSE: Patterns of flow in superficial and deep veins and outward flow in medial calf perforators were studied by duplex ultrasonography scanning in 1653 lower limbs in 1114 consecutive patients. This study compares results in 776 limbs with primary uncomplicated varicose veins with those in 166 limbs with the complications of lipodermatosclerosis or past venous ulceration. METHODS: Duplex scanning determined whether superficial and deep veins were occluded or showed reflux and whether outward flow occurred in medial calf perforators with calf muscle contraction. RESULTS: Two proximal deep veins were occluded. When limbs with primary uncomplicated varicose veins, lipodermatosclerosis, or past ulceration were compared, superficial reflux alone was seen in 55%, 39%, and 38%, deep reflux alone was seen in 2%, 7%, and 8%, and combined superficial and deep reflux was seen in 18%, 34%, and 48%, respectively. Superficial reflux affected the long saphenous system alone in 58%, 57%, and 40%, the short saphenous system alone in 18%, 18%, and 26%, and both the long and short saphenous systems in 24%, 25%, and 34%, respectively. Limbs with ulceration more frequently showed superficial reflux (p < 0.05), and all limbs with complications more frequently showed short saphenous reflux (p < 0.05) and deep reflux (p < 0.01) specifically in the posterior tibial veins (p < 0.01). Outward flow was seen in medial calf perforators in 57%, 67%, and 66%, respectively; it occurred more frequently in all limbs with complications (p < 0.05). Isolated outward flow in perforators without superficial or deep reflux was seen in 10%, 10%, and 2%, respectively. CONCLUSIONS: Most limbs with complications had superficial reflux either alone or combined with deep reflux, and few had deep reflux alone. Reflux was more frequent in posterior tibial veins for limbs with complications compared with those with uncomplicated primary varicose veins. Outward flow in perforators was common in limbs with complications and with uncomplicated primary varicose veins, but isolated outward flow in perforators was uncommon. Treatment directed to the superficial veins alone may be sufficient for most patients with complications. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/7707565/Duplex_ultrasonography_scanning_for_chronic_venous_disease:_patterns_of_venous_reflux_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S074152149500070X DB - PRIME DP - Unbound Medicine ER -