VENOUS REFLUX IN PATIENTS WITH PREVIOUS DEEP VENOUS THROMBOSIS - CORRELATION WITH ULCERATION AND OTHER SYMPTOMS

Purpose: Deep vein thrombosis (DVT) in many cases leads to chronic sym ptoms in the damaged leg, even though the affected veins have recanali zed. The major hemodynamic defect in such recanalized veins is reflux. The incidence and extent of reflux has been studied in patients with proven DVT and correlated with concurrent symptoms. Methods: Two hundr ed seventeen limbs in 183 patients were examined by duplex scanning fr om January 1989 to October 1992. All limbs had previous DVT diagnosed by venography. Sites and extent (proximal, distal, or both) of reflux were identified by meticulous duplex scanning of the whole venous syst em and correlated with presenting symptoms. Results: The patients were classified into nine groups on the basis of the classification of the system involved (superficial, deep, or superficial and deep) and whet her the reflux was found proximal or distal to the knee or both. Eight y-one limbs belong to chronic venous insufficiency class 1, 92 belong to class 2, and 38 belong to class 3. Reflux was confined to the deep venous system in 84 Limbs (38.7%), to the superficial system in 31 (14 .3%) limbs, and to both systems in 102 (47%) limbs. It was confined to proximal veins only in 48 (22.1%) limbs, distal only in 56 (25.8%) li mbs and throughout the Limb in 113 (52.1%) limbs. The incidence of swe lling was increased by distal or a combination of proximal and distal reflux regardless of which system was involved. In limbs with superfic ial venous insufficiency (SVI) or deep venous insufficiency (DVI) only , the incidence of skin changes was not affected by the extent of refl ux. However, in limbs with combined SVI and DVI, it was increased in t he presence of reflux throughout the limb. Absence of distal reflux wa s associated with a low incidence of skin changes even in the presence of DVI. Ulceration increased with an increased extent of reflux in th e presence of SVI. Absence of superficial reflux was associated with a low incidence, even in the presence of DVI. Conclusions: The data sug gest that as far as the skin changes and ulceration are concerned, dis tal reflux and reflux in the superficial veins are more harmful than r eflux confined to the deep veins, even when such reflux extends throug hout the deep venous system.