SUPERFICIAL VENOUS INSUFFICIENCY - CORRELATION OF ANATOMIC EXTENT OF REFLUX WITH CLINICAL SYMPTOMS AND SIGNS

Purpose: The aim of this study was to assess the distribution and exte nt of valvular incompetence in patients with reflux confined to the su perficial venous system and correlate the extent of such reflux with c linical symptoms and signs. Methods: Two hundred fifty-five limbs of 2 17 patients with superficial venous insufficiency and normal perforati ng and deep veins were examined with color-flow duplex imaging. One hu ndred twenty-three limbs (48.2%) of 102 patients had reflux confined t o the long saphenous system, 83 limbs (32.6%) of 72 patients had reflu x confined to the short saphenous system, and 49 limbs (19.2%) of 43 p atients had reflux in both long and short saphenous systems. Results: In the long saphenous system the commonest pattern of reflux was that which extended throughout the length of long saphenous vein (LSV) (47% ). Ache, swelling, and skin changes were common in the presence of bel ow knee reflux irrespective whether the thigh segment was involved. Ul ceration (8%) was found only in limbs with reflux extending throughout the length of LSV. In the shea saphenous system the most common patte rn of reflux extended throughout the length of short saphenous vein (S SV) (57%) without involvement of Giacomini or gastrocnemial veins. Ach e and swelling were present in 62% and 72% of the limbs, but this inci dence was not related to the extent of reflux. Swelling, skin changes, and ulceration occurred only when the whole of the SSV was involved. In the limbs with reflux in both the long and short saphenous systems, the most common pattern of reflux extended throughout the length of b oth systems (45%). In these limbs the incidence of swelling was 80%. T he incidence of skin changes went from 44% when the below-knee segment of the LSV was involved to 73% when reflux occurred throughout the LS V and SSV. Ulceration (14%) was found only in the latter situation. Va riable patterns of saphenogastrocnemial termination were seen. In 57.8 % of the limbs SSV joined the popliteal vein just above the popliteal crease, whereas the SSV terminated in the thigh in 26.6%. Conclusions: We conclude that ache, ankle edema, and skin changes in limbs with re flux confined to the superficial venous system are predominantly assoc iated with reflux in the below-knee veins. Ulceration is found only wh en the whole of the LSV is involved (8%) or when reflux is extensive i n both LSV and SSV (14%).