Anatomical Patterns in Varicose Vein Disease: A Duplex Scanning Study

Abstract

Objectives: To determine symptomatology, clinical class, and topographic patterns of varicose veins in a consecutive series of patients with venous complaints. Methods: We performed clinical examination and duplex scanning of 498 lower limbs in 317 patients with obvious varicose veins for whom no previous treatment had been undertaken. Results: Classes of chronic venous insufficiency (CVI) in 498 legs: grade 0: 117 (23.5%); gr 1: 310 (62.2%); gr 2: 47 (9.4%); gr 3: 24 (4.8%). Duplex-detected venous reflux was found in the greater saphenous vein territory (junction or trunk or related perforator or main tributary) in 423 limbs (85.3%) the sapheno-femoral junction was incompetent in only 342 legs (68.7%). Reflux was found in the lesser saphenous vein territory in 100 limbs (20.1%) and in sapheno-popliteal junction in 92 (18.5%). Strictly non saphenous origin of varicosities was found in 31 limbs (6.2%). Deep venous incompetence was found in 48 legs (9.6%). Conclusions: These findings yield data on the distribution and occurence of lower limbs venous lesions in patients with varicose disease.

The Incidence, Clinical Importance and Management of Incompetent Gastrocnemius Vein

“…12) In the early three cases and the great saphenous vein case, the incompetency of the GCV did not improve after saphenous vein surgery. Indeed in cases with varicose veins in the small saphenous territory, unmanaged incompetency of the GCV can be a cause of residual varicose veins, 10) as in our three early cases. A previous study showed that incompetency of the GCV was observed in over 30% of the recurrent cases during a longterm follow-up study after SSV surgery.…”

“…However, there are many perforating veins which penetrate the muscular fascia and connect the tributaries of the GCV to the superficial veins (indirect perforators). 10,[27][28][29] These are different from the perforating veins which connect deep veins, like the anterior or posterior tibial veins, to the superficial veins directly (direct perforators). The incompetency of the indirect perforators is therefore not due to such perforators themselves, but instead this phenomenon is thought to be due to the incompetency of the GCV root.…”

Pregnancy-induced changes in lower extremity superficial veins: An ultrasound scan study

“…The test for venous reflux was performed on duplex scan by the usual maneuvers of compressiondecompression and the Valsalva maneuver with the patient standing. 11 The entire superficial venous network was then examined. Veins were considered to be competent in the absence of reflux, whereas incompetent veins were defined by the presence of reflux (duration ≥ 1 second).…”

Ultrasound estimates of venous valve function in screening for insufficiency and following patients with chronic venous disease

“…3, 4). Several other investigators have corroborated this conclusion [3,11]. In one accepts the recirculation theory of venous insufficiency, the measurement of volume of reflux makes more physiologic sense than the time of reflux [3,10].…”

“…In addition, there is not a good correlation between VCT and clinical severity of venous disease [7,12,22]. The reflux/augmentation ratio, or reflux volume index (RVI), has been shown to be reliable in experimental [3] and clinical settings [2,[10][11]20]. The RVI has also been found to correlate well with clinical outcome in patients after venous valvuloplasty [18][19].…”