WHERE DOES VENOUS REFLUX START

Purpose: This study was designed to identify the origin of lower limb primary venous reflux in asymptomatic young individuals and to compare patterns of reflux with age-matched subjects with prominent or clinic ally apparent varicose veins. Methods: Forty age- and sex-matched subj ects with no symptoms (age, 15 to 35 years; 80 limbs; group A), 20 sub jects (age, 19 to 32 years; 40 limbs) with prominent but nonvaricose v eins (n = 26 limbs; group B), and 50 patients (age, 17 to 34 years; 10 0 limbs) with varicose veins (n = 64; group C) were examined with colo r flow duplex imaging. All proximal veins (above popliteal skin crease ), superficial, perforator, and deep, in the lower limb were examined in the standing position, and all the distal veins in the sitting posi tion. Patients who had a documented episode of superficial or deep vei n thrombosis, previous venous surgery, or injection sclerotherapy were excluded from the study. Results: The prevalence of reflux: in group A was 14% (11 of 80), in group B 77% (31 of 40), and in group C 87% (8 7 of 100). In more than 80% of limbs in the three groups, reflux was c onfined to the superficial veins alone. Deep venous reflux: or combine d patterns of reflux were uncommon even in group C. Reflux was detecte d in all segments of the saphenous veins and their tributaries. In the 125 limbs that had superficial venous incompetence, the below-knee se gment of the greater saphenous vein was the most common site of reflux (85, 68%), followed by the above-knee segment of greater saphenous ve in (69, 55%) and the saphenofemoral junction (41, 32%). Nonsaphenous r eflux was rare (3, 2.4%). Reflux in the lesser saphenous vein (21, 17% ) was seen in all groups, whereas involvement of both greater and less er saphenous veins (8, 6.4%) was seen in group C alone. The incidence of multisegmental reflux was significantly higher in group C (61 of 64 , 95%) than in group A (two of 11, 18%) or group B (14 of 26, 54%). Th e prevalence of distal reflux was comparable in all groups. Conclusion s: Primary venous reflux can occur in any superficial or deep vein of the lower limbs. The below-knee veins are often involved in asymptomat ic individuals and in these who have prominent or varicose veins. Thes e data suggest that reflux appears to be a local or multifocal process in addition to or separate from a retrograde process.