Comparison of venous reflux assessed by duplex scanning and descending phlebography in chronic venous disease

Baker, Stephen R.; Burnand, K. G.; Sommerville, K.; Thomas, M. Lea; Wilson, Nicholas; Browse, N L

doi:10.1016/0140-6736(93)92989-7

Cited by 123 publications

(72 citation statements)

References 9 publications

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“…25 Venous valves are difficult to image clearly with ultrasound. Venous valves ensure that venous blood flows centrally.…”

Section: Discussionmentioning

confidence: 99%

“…The most common criteria for pathological reflux were used, namely, peak reflux velocity Ͼ10 cm/s and duration of reflux Ͼ0.5 seconds after release of distal compression. 25,26 Pathological reflux was only diagnosed if both of the above criteria were fulfilled. Pathological reflux was categorized, therefore, as either "present" or "absent" for each venous segment (the statistical "nominal scale").…”

Section: Measurement Of Pathological Reflux On the Nominal Scalementioning

confidence: 99%

See 1 more Smart Citation

Mutations in FOXC2 Are Strongly Associated With Primary Valve Failure in Veins of the Lower Limb

Mellor

Brice²,

Stanton³

et al. 2007

Circulation

187

118

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Background— Mutations in the FOXC2 gene cause lymphedema distichiasis, an inherited primary lymphedema in which a significant number of patients have varicose veins. Because lymphedema distichiasis is believed to be caused by lymphatic valve failure (reflux), and FOXC2 is highly expressed on venous valves in mouse embryos, we tested the hypothesis that FOXC2 mutations may be linked to venous valve failure and reflux. Methods and Results— The venous system of the leg was investigated with Duplex ultrasound. Pathological reflux was recorded by color Duplex ultrasound in all 18 participants with a FOXC2 mutation, including 3 without lymphedema. Every participant with a mutation in FOXC2 showed reflux in the great saphenous vein (n=18), compared with only 1 of 12 referents (including 10 family members; P <0.0001, Fisher exact test). Deep vein reflux was recorded in 14 of 18 participants. Conclusions— FOXC2 is the first gene in which mutations have been strongly associated with primary venous valve failure in both the superficial and deep veins in the lower limb. This gene appears to be important for the normal development and maintenance of venous and lymphatic valves.

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“…25 Venous valves are difficult to image clearly with ultrasound. Venous valves ensure that venous blood flows centrally.…”

Section: Discussionmentioning

confidence: 99%

Section: Measurement Of Pathological Reflux On the Nominal Scalementioning

confidence: 99%

Mutations in FOXC2 Are Strongly Associated With Primary Valve Failure in Veins of the Lower Limb

Mellor

Brice²,

Stanton³

et al. 2007

Circulation

187

118

View full text Add to dashboard Cite

show abstract

“…58,59 In the diagnosis of venous reflux, duplex scanning has been shown to be superior to descending venography in correlating with the degree of venous reflux as measured by foot volumetry and with the clinical severity of disease as determined by clinical examination. [60][61][62][63] Duplex scanning is 84% sensitive and 88% specific in the diagnosis of deep venous insufficiency as compared with direct venous pressure measurements and venous filling times. 64 Arterial disease needs to be considered when evaluating patients with lower extremity ulcers.…”

Section: Diagnostic Testingmentioning

confidence: 99%

Chronic Venous Insufficiency and Venous Ulceration

Alguire

Mathes

1997

J Gen Intern Med

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OBJECTIVE:To review and summarize the literature on the normal venous circulation of the leg, and the epidemiology, pathophysiology, and treatment of chronic venous insufficiency (CVI).DATA SOURCES: English-language articles identified through a MEDLINE search using the terms venous insufficiency or varicose ulcer and epidemiology, pathophysiology, diagnosis, and clinical trial (pt), and selected cross-references. STUDY SELECTION:Articles on epidemiology, pathophysiology, and treatment of CVI. Randomized, controlled studies were specifically sought for treatment efficacy. DATA EXTRACTION:Data were manually extracted from selected studies and reviews; emphasis was placed on information relevant to the general internist. pproximately 5 million people in the United States exhibit some evidence of chronic venous insufficiency (CVI) and between 400,000 and 500,000 of these individuals have or will develop a venous leg ulcer. 1-3 The signs of CVI include engorgement of the cutaneous veins and dependent edema in mildly affected patients to pigmentation, dermatitis, and ulceration in the more severe cases. Although most patients are asymptomatic, others have leg heaviness and aching or recurrent and recalcitrant leg ulcers punctuated by bouts of cellulitis. These more severe cases are associated with recurrent hospitalization, high health-care costs, and disability. 4,5 Venous insufficiency with trophic skin changes or ulceration is a frustrating problem, which many physicians approach with a sense of ennui. This may be due to the chronic and remitting nature of the problem, the need for lifestyle modification, inconvenient therapies, and contradictory information regarding medical and surgical management. Nevertheless, CVI, including ulceration, is a manageable problem. The purpose of this review is to present the normal anatomy and physiology of the venous circulation and to summarize the epidemiology, pathophysiology, and treatment of CVI. DATA SYNTHESIS: METHODSA MEDLINE search for relevant English-language articles published between 1966 and 1996 was completed using the following MeSH terms: venous insufficiency or varicose ulcer and epidemiology, pathophysiology, diagnosis, and clinical trial (pt). When selecting articles on treatment, randomized, controlled trials were reviewed whenever possible. Emphasis was placed on reviewing articles with clinical relevance for internal medicine physicians. ANATOMY AND NORMAL PHYSIOLOGYVenous blood from the skin and subcutaneous fat is collected in a system of superficial venules and veins that drain toward the deep venous system underneath the fascia via three major pathways: (1) through the long or short saphenous veins, which join the deep system at the saphenofemoral and saphenopopliteal junctions; (2) through the perforating veins originating from the long or short saphenous veins or their branches; or (3) directly into the deep venous system or bypass the deep system entirely and enter the pelvis. 6 Deep veins are categorized as either intramuscular or intermuscular; o...

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“…The refl ux was elicited by Valsalva manoeuvre presented for 5-10 seconds, and was defi ned as a backfl ow lasting ≥ 1 s (ref. 1,6,10,11 ). Haemodynamically signifi cant refl ux had a backfl ow velocity of Vmax ≥ 10 cm/s.…”

Section: Methodsmentioning

confidence: 99%

Width of the Great Saphenous Vein Lumen in the Groin and Occurence of Significant Reflux in the Sapheno-Femoral Junction

Musil

Herman²,

Mazuch³

2008

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim:This study was performed to assess the contribution of the width of the anechogenous lumen of the great saphenous vein (GSV) in the groin measured by ultrasound (US) to the diagnostics of haemodynamically signifi cant refl ux (HSR) in the sapheno-femoral junction (SFJ).Methods: We examined 200 lower limbs with primary varicose veins in 182 patients. Duplex scanning was performed with the patients in the supine position. Longitudinaly imaging (B-mode) the inner anechogenous diameter of GSV was measured 4-5 cm distal to SFJ. PW Doppler sampling volume was placed at the same distance. The refl ux was elicited by Valsalve manoeuvre. The HSR was defi ned as a backfl ow lasting ≥ 1 s with a velocity of Vmax ≥ 10 cm/s.Results: The mean width of the GSV with HSR (n=152) was 6.39 mm, median 6.0 mm, SD ± 2.21 mm. The mean width of GSV without HSR (n = 48) was 4.41 mm, median 4.4 mm, SD ± 0.96 mm. The diff erence between the mean widths of GSV was statistically signifi cant (p < 0.01). In GSV < 5 mm (n = 77) HSR (V max ≥ 10 cm/s) was confi rmed in 46 cases (59.7 %), in GSV ≥ 5 mm (n = 123) in 106 cases (86.2 %). The sensitivity of dilatation of GSV ≥ 5 mm for the presence of HSR in SFJ was 69.7 %, specifi city 64.6 %. PPV (positive predictive value) of dilatation of GSV ≥ 5 mm for the presence of HSR in SFJ was 86.2 %, NPV (negative predictive value) was 40.3 %, and the diagnostic accuracy of dilatation of GSV ≥ 5 mm was 68.5 %.Conclusions: Measurement of anechogenous lumen GSV under the groin in B-mode is less sensitive (69.7 %) and less specifi c (64.6 %) in the diagnostics of HSR in SFJ. Only 68.5 % of all measurements of the width of the GSV below the groin in B-mode provided accurate indirect assessment of the functions of valves in SFJ. US scanning of the width of anechogenous lumen of GSV below the groin may serve only for ancillary examination. INTRODUCTIONIn ultrasound examination for venous insuffi ciency of the lower extremities we use duplex scanning to assess the function of venous valves and search for the refl ux. Morphological evaluation of the vein in B-mode (when we focus on the measurement of the anechogenous venous lumen) is only secondary. In case of venous dilatation we consider venous insuffi ciency. Sometimes it is possible to scan venous valves, their motility and reaction to Valsalva manoeuvre or manual compression. However, minor venous valves are diffi cult to scan. The new generation of ultrasonographic devices makes it possible to follow their function and blood-fl ow under both physiological and pathological conditions 12 . In lower extremities with primary varicose veins we can observe insuffi ciency of the sapheno-femoral junction (SFJ) most frequently 7,15 . The cause of trunk varices of the great saphenous vein (GSV) is refl ux in the terminal and preterminal valves in the sapheno-femoral junction 3 . Recent work has already evaluated the relation between the width of GSV and the occurrence of the refl ux in SFJ, and found a statistically

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Comparison of venous reflux assessed by duplex scanning and descending phlebography in chronic venous disease

Cited by 123 publications

References 9 publications

Mutations in FOXC2 Are Strongly Associated With Primary Valve Failure in Veins of the Lower Limb

Mutations in FOXC2 Are Strongly Associated With Primary Valve Failure in Veins of the Lower Limb

Chronic Venous Insufficiency and Venous Ulceration

Width of the Great Saphenous Vein Lumen in the Groin and Occurence of Significant Reflux in the Sapheno-Femoral Junction

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