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Objective: To quantify venous reflux by a standard duplex ultrasound technique and correlate the data obtained with clinical grades of severity of venous disease. Design: A prospective study in a single group of patients with venous insufficiency. Setting: Private practice in secondary and tertiary care. Patients: 133 inpatients undergoing investigation for venous disease. Patients with known venous obstruction, arterio-venous malformations or lymphoedema were excluded from the study. Main outcome measures: Duplex ultrasound scanning was performed to measure the cross-sectional area, severity and duration of venous reflux following calf compression using a standardized technique. Results: Clinical classification assigned to each limb correlated with the presence of venous reflux, but not the quantity, velocity or duration of reflux in the veins studied. Presence of reflux and diameter of the vein studied correlated ( p<0.001) in all the veins except the popliteal vein ( p > 0.03). Conclusion: Quantification of venous reflux obtained by cuff deflation does not correlate with clinical severity of venous stasis, but does detect reflux accurately. This allowed greater saphenous sparing in nine limbs in 41 patients but proved the need for saphenous removal in seven limbs not previously suspected clinically of requiring this procedure.

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In limbs with chronic venous insufficiency (CVI), the presence of popliteal vein reflux has correlated with severity of venous insufficiency. Correction of proximal deep venous reflux has improved clinical manifestations of CVI, but the hemodynamic results of doing so have been disappointing. The present study was done to ascertain the effects of proximal reflux upon distal vein function.A total of 226 patients (175 women, 51 men) entered this study. Venous insufficiency in each of 450 limbs was classified according to Joint Councils' recommendations, and reflux was assessed by a modification of a method of Nicolaides and of van Bemmelen. Reflux in the femoral vein (FV), greater saphenous vein (GSV), popliteal vein (PV), and lesser saphenous vein (LSV) of the nonweight-bearing limb was quantitated by using the ATL 9 duplex scanner with a 5 MHz probe during rapid distal pneumatic cuff deflation. Data obtained included vein diameter, reflux volume, and reflux peak velocity. Limbs with PV reflux with and without FV reflux were then compared with those without PV reflux with and without FV reflux according to sex.The men in this study group were older than the women (P < 0.05) and had a more advanced stage of venous insufficiency (P < 0.001). Therefore, analyses were performed separately in men and women. In men,