DUPLEX ASSESSMENT OF VENOUS REFLUX AND CHRONIC VENOUS INSUFFICIENCY -THE SIGNIFICANCE OF DEEP VENOUS REFLUX

Purpose: This study was undertaken to examine the role of superficial and deep venous reflux, as defined by duplex-derived valve closure tim es (VCTs), in the pathogenesis of chronic venous insufficiency. Method s: Between January 1992 and November 1995, 320 patients and 500 legs w ere evaluated with clinical examinations and duplex scans for potentia l venous reflux. VCTs were obtained with the cuff deflation technique with the patient in the upright position. Imaging was performed at the saphenofemoral junction, the middle segment of the greater saphenous vein, the lesser saphenous vein, the superficial femoral vein, the pro funda femoris vein, and the popliteal vein. Not all patients had all s egments examined because tests early in the series did not examine the profunda femoris or lesser saphenous vein and because some patients h ad previous Ligation and stripping or venous thrombosis. VCTs were exa mined for individual segment reflux, grouped into superficial and deep systems, and then correlated with the clinical stage as defined by th e SVS/ISCVS original reporting standards in venous disease. Segment re flux was considered present if the VCT was greater than 0.5 seconds, a nd system reflux was considered present if the sum of the segments was greater than 1.5 seconds. Between-group differences were analyzed wit h analysis of variance and post hoc tests where appropriate. Results: Sixty-nine limbs studied were in class 0, 149 limbs were in class 1, 1 68 Limbs were in class 2, and 114 limbs were in class 3. VCTs in the s uperficial veins were significantly lower in class 0 than in the other clinical classes. There was no difference in superficial reflux in th e symptomatic limbs (classes 1 to 3). Reflux VCTs in the superficial f emoral and popliteal veins increased as the clinical symptoms progress ed, with a significant increase in class 3 ulcerated Limbs when compar ed with nonulcerated limbs. The incidence of deep venous reflux was 60 % in class 3 limbs, compared with 29% in class 2 limbs, whereas the in cidence of superficial venous reflux did not differ among the symptoma tic limbs. Isolated superficial femoral and popliteal vein reflux was uncommon, even in class 3 limbs, but combined superficial femoral and popliteal vein reflux was found in 53% of class 3 limbs, compared with 18.5% of class 2 limbs. Conclusions: Reflux in the deep venous system plays a significant role in the progression of chronic venous insuffi ciency. Deep system reflux increases as clinical changes become more s evere, with significant axial reflux contributing to ulcer formation.