CHRONIC VENOUS INSUFFICIENCY IN A CHINESE POPULATION - AN ANATOMIC AND FUNCTIONAL-STUDY BY CONTINUOUS-WAVE DOPPLER AND PHOTOPLETHYSMOGRAPHY

A total of 1583 limbs in 878 patients who presented with symptoms of c hronic venous insufficiency of the lower limbs were examined in the va scular laboratory. The anatomic distribution of valvular insufficiency was determined by continuous-wave Doppler ultrasound and functional s everity was determined by the venous refilling time (VRT) using photop lethysmography. Severity of reflux was assessed using a four-class gra ding scale (classes 0 to 3) based on clinical and VRT criteria. A mixe d incompetence of the valves in the superficial system and the perfora tors was encountered in the majority of patients (44% in class 0 and 8 5% in class 3). Deep vein incompetence was less common and usually con sisted of isolated proximal incompetence of the common femoral vein (u p to 32% in class 3) or was of a mixed type (21% in class 3). Isolated distal deep vein incompetence was uncommon. Proximal femoral vein inc ompetence and superficial system incompetence at the saphenofemoral ju nction were associated with severe reflux. There was significant impro vement in the VRT in patients with more severe reflux (class 2 or 3) a fter application of an ankle tourniquet. Symptoms of moderate to sever e chronic venous insufficiency and ankle ulceration may be a result of long-standing superficial system incompetence rather than deep venous disease and may thus be amendable to simple saphenofemoral ligation a nd interruption of perforators.