DISTRIBUTION AND QUANTIFICATION OF VENOUS REFLUX IN LOWER-EXTREMITY CHRONIC VENOUS STASIS DISEASE WITH DUPLEX SCANNING

Purpose: The purpose of this study was to use color-flow duplex scanni ng to identify the anatomic distribution of venous reflux and to quant ify venous reflux times in patients with various stages of chronic ven ous insufficiency (CVI).Methods: Color-flow-assisted duplex scanning w as used to identify the anatomic distribution of venous reflux and to quantify reflux times in the deep and superficial venous systems of pa tients with symptomatic (CVI). Two hundred two patients with class I t o III CVI were examined. Results: Only 11% (22 patients) had a documen ted history of phlebothrombosis. Of the 403 limbs evaluated, 192 had v enous ulcers whereas 211 were classified as having class I or Il CVI. Nonocclusive venous obstruction was found in only 16 limbs (4%). Venou s ulceration was significantly associated with reflux in multiple veno us segments as opposed to reflux in isolated venous segments (p < 0.00 1). Total limb reflux time (R(t)) was determined by summing the reflux times of all the venous segments in a limb. The mean R(t) of patients with venous ulcerations was significantly longer than the mean R(t) o f limbs with class I and II CVI (p < 0.01). A total limb reflux time o f greater than 9.66 seconds was predictive of ulceration. Total limb d eep segment reflux time and total limb superficial segment reflux time were also determined by summing the reflux times of the appropriate s egments in the limb. The mean deep segment reflux time was prolonged i n limbs with venous ulcers when compared with limbs with class I and I I CVI disease. The mean superficial segment reflux time of limbs with class I and II CVI and limbs with venous ulcers could not be used to d istinguish between the two groups. In assessing the contribution of se gments of the deep system to ulceration, reflux times of different seg ments were compared with wound duration and area. Reflux in the common femoral vein was significantly associated with wound area and duratio n (p < 0.05) whereas reflux time in the distal posterior tibial vein w as associated with wound duration (p < 0.05).