Diameter-reflux relationship in perforating veins of patients with varicose veins

Purpose: Treatment of chronic venous valvular insufficiency requires unders tanding of the hemodynamics of perforating veins. To preserve normal veins or veins that can function normally once primary sources of valvular insuff iciency are removed, a better understanding of the diameter-reflux relation ship is desirable. We measured reflux and diameters in 500 perforating vein s of patients with varicose veins (C(2)E(P)A(SP)P(R)). Methods: Color flow duplex ultrasonography scanning was performed with the patient standing. Perforating veins were mapped medially in the thigh and m edially, laterally, and posteriorly in the calf. Reflux was defined as reve rse flow that lasted longer than 0.5 seconds. Diameters were measured on B- mode transverse projections at the crossing of the fascia. Competent versus incompetent vein diameters were compared by means of Student t test, one-w ay analysis of variance, and Bonferroni t test. Results: Diameters of competent and incompetent perforators averaged 2.5 +/ - 0.9 mm (n = 17) and 4.7 +/- 1.9 mm (n = 17) at the medial thigh (P <.0002 ), 2.2 +/- 0.8 mm (n = 179) and 3.7 +/- 1.0 mm (n = 210) at the medial calf (P <.0001), 2.2 +/- 0.6 mm (n = 13) and 3.5 +/- 0.8 mm (n = 37) at the pos terior calf(P <.0001), and 2.1 +/- 0.8 mm (n = 9) and 3.3 +/- 0.7 mm (n = 1 8) at the lateral calf (P <.003), respectively. Perforating Vein diameters of 3.5 mm or larger in the calf and thigh were associated with reflux in mo re than 90% of the cases. Conclusion: An enlargement in the diameter of the perforating veins of 1 to 1.5 mm in the calf or 2 mm in the thigh of patients with varicose veins co uld be the difference between normal flow and reflux. Further studies are n eeded to confirm if elimination of reflux in patients with primary varicosi ty will transform incompetent perforators to competent ones.