Duplex Ultrasound Scanning for Chronic Venous Disease: The Frequency of Reflux in the Crural Veins

Abstract

Objective: To use duplex ultrasound scanning to determine the frequency of reflux in crural veins and its relation to the presentation, reflux in superficial and other deep veins, and outward flow in perforators in patients referred for assessment of chronic venous disease. Design: Scanning of superficial, deep and perforator veins. Setting: A vascular diagnostic laboratory in Melbourne, Australia. Patients: A study of 2590 lower limbs in 1684 consecutive patients. Main outcome measure: The frequency of reflux in crural veins. Results: The posterior tibial, anterior tibial and peroneal veins were identified in 98%, 95% and 95% and reflux was observed in 5%, 2% and 3%, respectively. Posterior tibial reflux was twice as frequent as reflux in the anterior tibial and/or peroneal veins alone. Posterior tibial reflux was significantly more frequent if there were clinical complications (19% of limbs with previous ulceration or lipodermatosclerosis), short saphenous reflux alone (8%) or both long and short saphenous reflux (11%), popliteal reflux (28%), or outward flow in medial calf perforators (6%) ( p<0.0001 for each). Posterior tibial reflux was no more frequent if there was Jong saphenous reflux alone or femoral reflux alone. Anterior tibial and/or peroneal reflux without posterior tibial reflux was not significantly related to the clinical presentation or reflux at any other site. Conclusions: The association of posterior tibial reflux with clinical complications, short saphenous reflux (alone or associated with long saphenous reflux), popliteal reflux or outward flow in perforators observed with duplex scanning contrasted with the lack of any such associations for anterior tibial or peroneal reflux without posterior tibial reflux. Scanning the anterior tibial and peroneal veins may add little to the examination.