Proximal Reflux Adversely Affects Distal Venous Function

Abstract

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,

Chronic venous ulcer

“…Hanrahan et al studied 95 cases of venous ulceration with duplex ultrasonography: they found that 16% of the affected legs had only superficial incompetence while 19% had superficial incompetence combined with perforating vein incompetence–thus, 35% of cases were potentially curable by simple surgery 28. Our own study of 58 cases of severe chronic venous insufficiency showed that 17% of the affected legs exhibited only superficial reflux and that superficial reflux was a major contributor to chronic venous dysfunction in another 17 limbs 29. Reflux proceeding distally down the greater saphenous vein and re-entering perforating veins in the proper direction may overload the deep vein system and cause elongation and dilatation of the deep vessels so that their valves become incompetent.…”