Distribution and quantification of venous reflux in lower extremity chronic venous stasis disease with duplex scanning

Abstract

Purpose: The purpose of this study was to use color-flow duplex scanning to identify the anatomic distribution of venous reflux and to quantify venous reflux times in patients with various stages of chronic venous insufficiency (CVI).Methods: Color-flow—assisted duplex scanning was used to identify the anatomic distribution of venous reflux and to quantify reflux times in the deep and superficial venous systems of patients with symptomatic (CVI). Two hundred two patients with class I to III CVI were examined.Results: Only 11% (22 patients) had a documented history of phlebothrombosis. Of the 403 limbs evaluated, 192 had venous ulcers whereas 211 were classified as having class I or II CVI. Nonocclusive venous obstruction was found in only 16 limbs (4%). Venous ulceration was significantly associated with reflux in multiple venous segments as opposed to reflux in isolated venous segments (p < 0.001). Total limb reflux time (Rt) was determined by summing the reflux times of all the venous segments in a limb. The mean Rt of patients with venous ulcerations was significantly longer than the mean Rtof limbs with class I and II CVI (p < 0.01). A total limb reflux time of greater than 9.66 seconds was predictive of ulceration. Total limb deep segment reflux time and total limb superficial segment reflux time were also determined by summing the reflux times of the appropriate segments in the limb. The mean deep segment reflux time was prolonged in limbs with venous ulcers when compared with limbs with class I and II CVI disease. The mean superficial segment reflux time of limbs with class I and II CVI and limbs with venous ulcers could not be used to distinguish between the two groups. In assessing the contribution of segments of the deep system to ulceration, reflux times of different segments were compared with wound duration and area. Reflux in the common femoral vein was significantly associated with wound area and duration (p < 0.05) whereas reflux time in the distal posterior tibial vein was associated with wound duration (p < 0.05).