Non-Thrombotic Deep Venous Incompetence with Special Reference to Anatomic, Haemodynamic and Therapeutic Aspects

Abstract

This investigation was undertaken to study non-thrombotic deep venous insufficiency (DVI) in patients with varicose veins or other venous symptoms. Deep venous reflux was observed in 3.5% of the ‘normal’ limbs in patients with unilateral varicose veins. A high incidence of reflux was found in limbs with untreated (21%, P < 0.001) and with recurrent varicose veins (43%, P < 0.001) compared with that in ‘normal’ limbs. Among patients with non-thrombotic DVI the most common patterns were isolated reflux in the superficial femoral vein (51%), and combined reflux in the superficial and deep femoral veins (44%). Isolated reflux in the deep femoral vein occured in 5%. Complete visualization of the deep femoral vein is a new diagnostic sign that strongly correlates ( P < 0.001) with reflux in this vein. femoropopliteal and isolated popliteal reflux caused abnormal venous pressure values even in asymptomatic patients. Incompetence of calf perforators strongly influenced these values. Varicose vein surgery in limbs with a strong calf muscle pump resulted in significant improvement in venous pressure. The long-term results of valvuloplasty were good in 67% of the extremities. A significant improvement in venous pressure was observed in limbs with competent deep femoral vein valves, which suggests that the functional state of this vein is of great haemodynamic importance.