Most incompetent calf perforating veins are found in association with superficial venous reflux

Purpose: The indications for surgical perforator interruption remain undefi ned. Previous work has demonstrated an association between clinical status and the number of incompetent perforating veins (IPVs). Other studies have demonstrated that correction of IPV physiology results:ft-om abolition of s aphenous system reflux. The purpose of this study was to identify which, if any, patterns of venous reflux and obstruction are particularly associated with IPV. Patients and Methods: Two hundred thirty patients and subjects (103 men, 12 7 women, 308 limbs) with varying grades of venous disease were examined bot h clinically and with duplex ultrasound scan. The odds ratios (ORs) for the presence of IPVs were calculated for different anatomical distributions of main-stem venous reflux and obstruction. The base group are those with no main-stem venous disease. Results. There were no significant associations between the proportions of limbs demonstrating IPVs and patient age or sex. The ORs for the presence o f IPVs in association with other venous disease are as follows (age/sex adj usted): long saphenous vein reflux, OR = 1.86, range = 1.32-2.63; short sap henous vein reflux, OR = 1.36, range = 1.02-1.82; deep system venous reflux , OR = 1.61, range = 1.2-2.15; superficial system reflux, OR = 3.17, range = 1.87-5.4; Ind deep system obstruction, OR = 1.09, range = 0.51-2.33. The ORs for combinations of venous disorders were calculated. Combinations of d isease produced higher odds for the presence of IPVs than those above, the highest being long saphenous vein, short saphenous vein, and deep reflux co mbined, OR = 6.85 (95% CI, 2.97-15.83; P = .0001). Conclusions. Although the presence of IPVs is associated with venous ulcera tion, the highest ORs for the presence of IPVs were found in patients with superficial disease alone or in combination with deep reflux. Many of these may be corrected by saphenous surgery alone.