Prevalence of deep venous reflux in patients with primary superficial veinincompetence

Purpose: This prospective study was designed to determine the prevalence of deep reflux and the conditions under which it may occur in patients with p rimary superficial venous reflux and absence of deep venous thrombosis (DVT ). Methods: We studied 152 limbs in 120 consecutive patients in the standing p osition who had superficial venous reflux with color flow duplex scanning. Limbs with documented evidence of DVT or post-thrombotic vein wall changes during the examination were studied but not included in the analysis. Limbs were divided into those that had at least reflux in the saphenofemoral, th e saphenopopliteal, or the gastropopliteal junction and into those with non junctional reflux in the superficial and gastrocnemial veins. Peak velocity and duration of reflux were measured. To examine the recirculation theory, we tested the deep veins by occluding and refluxing saphenous veins 10 cm below the sampling site. Results: Thirteen limbs in II patients (9%) were excluded because of previo us DVT. Of the remaining 139 limbs, 106 (76%) had junctional reflux. Saphen ofemoral junction was involved in 89 limbs (84%), saphenopopliteal junction in 18 (17%), and gastropopliteal junction in 7 (4%). In 33 limbs (24%), re flux was detected in the main trunk or tributaries of the saphenous veins a lone with no junctional incompetence. Femoral or popliteal reflux was prese nt in 31 limbs (22%). This reflux was segmental in 27 limbs, and it was lim ited in the junction in 24 limbs. The mean duration of deep venous reflux w as 0.9 seconds, it ranged from 0.6 to 3.7 seconds, and it was significantly shorter than that in the superficial veins (2.6 seconds; P < .0001). In th e absence of junctional reflux, the prevalence of deep venous insufficiency (DVI) was significantly lower compared with that in limbs with junctional involvement (2 of 33 vs 29 of 106; P = .038). The mean duration of deep ven ous reflux in these groups was comparable (0.85 seconds vs 0.91 seconds; P = .44). Occlusion of the incompetent superficial veins reduced somewhat the duration of the deep venous reflux but did not abolish it (0.88 seconds vs 0.82 seconds; P = .072). The presence of DVI was associated with junctiona l reflux of high peak velocity and long duration. Conclusions: The prevalence of DVI in patients with primary superficial ven ous reflux and without history of DVT is 22%. However, this reflux is segme ntal, mainly in the common femoral vein, and is of short duration. It is as sociated with the presence of junctional incompetence that has a high peak velocity and long duration. These findings may explain why surgical correct ion of superficial reflux abolishes DVI.