N. Labropoulos et al., VENOUS REFLUX IN PATIENTS WITH PREVIOUS DEEP VENOUS THROMBOSIS - CORRELATION WITH ULCERATION AND OTHER SYMPTOMS, Journal of vascular surgery, 20(1), 1994, pp. 20-26
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.