DUPLEX ULTRASONOGRAPHY SCANNING FOR CHRONIC VENOUS DISEASE - PATTERNSOF VENOUS REFLUX

Purpose: Patterns of flow in superficial and deep veins and outward fl ow in medial calf perforators were studied by duplex ultrasonography s canning in 1653 lower limbs in 1114 consecutive patients. This study c ompares results in 776 limbs with primary uncomplicated varicose veins with those in 166 limbs with the complications of lipodermatosclerosi s or past venous ulceration. Methods: Duplex scanning determined wheth er superficial and deep veins were occluded or showed reflux and wheth er outward flow occurred in medial calf perforators with calf muscle c ontraction. Results: Two proximal deep veins were occluded. When limbs with primary uncomplicated varicose veins, lipodermatosclerosis, or p ast ulceration were compared, superficial reflux alone was seen in 55% , 39%, and 38%, deep reflux alone was seen in 2%, 7%, and 8%, and comb ined superficial and deep reflux was seen in 18%, 34%, and 48%, respec tively. Superficial reflux affected the long saphenous system alone in 58%, 57%, and 40%, the shea saphenous system alone in 18%, 18%, and 2 6%, and both the long and short saphenous systems in 24%, 25%, and 34% , respectively. Limbs with ulceration more frequently showed superfici al reflux (p < 0.05), and all limbs with complications more frequently showed short saphenous reflux (p < 0.05) and deep reflux (p < 0.01) s pecifically in the posterior tibial veins (p < 0.01). Outward flow was seen in medial calf perforators in 57%, 67%, and 66%, respectively; i t occurred more frequently in all limbs with complications (p < 0.05). Isolated outward dow in perforators without superficial or deep reflu x was seen in 10%, 10%, and 2%, respectively. Conclusions: Most limbs with complications had superficial reflux either alone or combined wit h deep reflux, and few had deep reflux alone. Reflux was more frequent in posterior tibial veins for limbs with complications compared with those with uncomplicated primary varicose veins. Outward flow in perfo rators was common in limbs with complications and with uncomplicated p rimary varicose veins, but isolated outward flow in perforators was un common. Treatment directed to the superficial veins alone may be suffi cient for most patients with complications.