Gravitational Reflux Does Not Correlate with Clinical Status of Venous Stasis

Abstract

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.

Does surgical correction of the superficial femoral vein valve change the course of varicose disease?

“…It has been shown by others that RT does not correlate with physiologic parameters such as volume of reflux and venous pressure. [16][17] Moreover, changes in RT were found not to correlate with clinical changes. 18 On the basis of these reports and our own observations, we believe that RT cannot be used for reflux quantification or for measurement of changes in reflux.…”

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

“…However, various authors cite different values for the VCT to be considered abnormal [7][8][14][15][24][25]. 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].…”

Experience with Classification of Venous Disorders

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218 perforator veins; and its pathophysiology (P) of reflux or obstruction, or both, with the segmental distribution of these changes (18 segments).A shorthand method of writing the CEAP classification was adopted using mnemonics, as follows: C (1-6)-(s/a)-E-p,s,or c-A (s, p, or d)-P (r, o, or r/o) (segmental distribution [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] where: C = clinical state 1 to 6 (s/a) = symptomatic or asymptomatic (pain, itching, etc) E = etiology, whether primary, secondary, or congenital A = anatomic location, whether superficial, perforator, or deep P = pathophysiology, whether reflux, obstruction, or both In addition to the delineation of the C-E-A-P characteristics, the committee devised a method of scoring the amount of disease and a method of estimating the impact upon the patient with a disability score.In actual practice the classification is easy to apply in the simpler and more frequent clinical problems, and more demanding in the complex problems. For instance, the most frequent venous patients are those with telangiectases and those with uncomplicated varicose veins.

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