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Duplex assessment of venous reflux and chronic venous insufficiency: the significance of deep venous reflux.
J Vasc Surg 1996; 24(5):755-62JV

Abstract

PURPOSE

This study was undertaken to examine the role of superficial and deep venous reflux, as defined by duplex-derived valve closure times (VCTs), in the pathogenesis of chronic venous insufficiency.

METHODS

Between January 1992 and November 1995, 320 patients and 500 legs were evaluated with clinical examinations and duplex scans for potential venous reflux. VCTs were obtained with the cuff deflation technique with the patient in the upright position. Imaging was performed at the saphenofemoral junction, the middle segment of the greater saphenous vein, the lesser saphenous vein, the superficial femoral vein, the profunda femoris vein, and the popliteal vein. Not all patients had all segments examined because tests early in the series did not examine the profunda femoris or lesser saphenous vein and because some patients had previous ligation and stripping or venous thrombosis. VCTs were examined for individual segment reflux, grouped into superficial and deep systems, and then correlated with the clinical stage as defined by the SVS/ISCVS original reporting standards in venous disease. Segment reflux was considered present if the VCT was greater than 0.5 seconds, and system reflux was considered present if the sum of the segments was greater than 1.5 seconds. Between-group differences were analyzed with analysis of variance and post hoc tests where appropriate.

RESULTS

Sixty-nine limbs studied were in class 0, 149 limbs were in class 1, 168 limbs were in class 2, and 114 limbs were in class 3. VCTs in the superficial veins were significantly lower in class 0 than in the other clinical classes. There was no difference in superficial reflux in the symptomatic limbs (classes 1 to 3). Reflux VCTs in the superficial femoral and popliteal veins increased as the clinical symptoms progressed, with a significant increase in class 3 ulcerated limbs when compared with nonuclerated limbs. The incidence of deep venous reflux was 60% in class 3 limbs, compared with 29% in class 2 limbs, whereas the incidence of superficial venous reflux did not differ among the symptomatic limbs. Isolated superficial femoral and popliteal vein reflux was uncommon, even in class 3 limbs, but combined superficial femoral and popliteal vein reflux was found in 53% of class 3 limbs, compared with 18.5% of class 2 limbs.

CONCLUSIONS

Reflux in the deep venous system plays a significant role in the progression of chronic venous insufficiency. Deep system reflux increases as clinical changes become more severe, with significant axial reflux contributing to ulcer formation.

Authors+Show Affiliations

Division of Vascular Surgery, New England Medical Center Hospital, Boston, MA 02111, 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

8918320

Citation

Welch, H J., et al. "Duplex Assessment of Venous Reflux and Chronic Venous Insufficiency: the Significance of Deep Venous Reflux." Journal of Vascular Surgery, vol. 24, no. 5, 1996, pp. 755-62.
Welch HJ, Young CM, Semegran AB, et al. Duplex assessment of venous reflux and chronic venous insufficiency: the significance of deep venous reflux. J Vasc Surg. 1996;24(5):755-62.
Welch, H. J., Young, C. M., Semegran, A. B., Iafrati, M. D., Mackey, W. C., & O'Donnell, T. F. (1996). Duplex assessment of venous reflux and chronic venous insufficiency: the significance of deep venous reflux. Journal of Vascular Surgery, 24(5), pp. 755-62.
Welch HJ, et al. Duplex Assessment of Venous Reflux and Chronic Venous Insufficiency: the Significance of Deep Venous Reflux. J Vasc Surg. 1996;24(5):755-62. PubMed PMID: 8918320.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Duplex assessment of venous reflux and chronic venous insufficiency: the significance of deep venous reflux. AU - Welch,H J, AU - Young,C M, AU - Semegran,A B, AU - Iafrati,M D, AU - Mackey,W C, AU - O'Donnell,T F,Jr PY - 1996/11/1/pubmed PY - 2001/3/28/medline PY - 1996/11/1/entrez SP - 755 EP - 62 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 24 IS - 5 N2 - PURPOSE: This study was undertaken to examine the role of superficial and deep venous reflux, as defined by duplex-derived valve closure times (VCTs), in the pathogenesis of chronic venous insufficiency. METHODS: Between January 1992 and November 1995, 320 patients and 500 legs were evaluated with clinical examinations and duplex scans for potential venous reflux. VCTs were obtained with the cuff deflation technique with the patient in the upright position. Imaging was performed at the saphenofemoral junction, the middle segment of the greater saphenous vein, the lesser saphenous vein, the superficial femoral vein, the profunda femoris vein, and the popliteal vein. Not all patients had all segments examined because tests early in the series did not examine the profunda femoris or lesser saphenous vein and because some patients had previous ligation and stripping or venous thrombosis. VCTs were examined for individual segment reflux, grouped into superficial and deep systems, and then correlated with the clinical stage as defined by the SVS/ISCVS original reporting standards in venous disease. Segment reflux was considered present if the VCT was greater than 0.5 seconds, and system reflux was considered present if the sum of the segments was greater than 1.5 seconds. Between-group differences were analyzed with analysis of variance and post hoc tests where appropriate. RESULTS: Sixty-nine limbs studied were in class 0, 149 limbs were in class 1, 168 limbs were in class 2, and 114 limbs were in class 3. VCTs in the superficial veins were significantly lower in class 0 than in the other clinical classes. There was no difference in superficial reflux in the symptomatic limbs (classes 1 to 3). Reflux VCTs in the superficial femoral and popliteal veins increased as the clinical symptoms progressed, with a significant increase in class 3 ulcerated limbs when compared with nonuclerated limbs. The incidence of deep venous reflux was 60% in class 3 limbs, compared with 29% in class 2 limbs, whereas the incidence of superficial venous reflux did not differ among the symptomatic limbs. Isolated superficial femoral and popliteal vein reflux was uncommon, even in class 3 limbs, but combined superficial femoral and popliteal vein reflux was found in 53% of class 3 limbs, compared with 18.5% of class 2 limbs. CONCLUSIONS: Reflux in the deep venous system plays a significant role in the progression of chronic venous insufficiency. Deep system reflux increases as clinical changes become more severe, with significant axial reflux contributing to ulcer formation. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/8918320/Duplex_assessment_of_venous_reflux_and_chronic_venous_insufficiency:_the_significance_of_deep_venous_reflux_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(96)70009-5 DB - PRIME DP - Unbound Medicine ER -