Patterns of Venous Reflux and Obstruction in Patients With Skin Damage Due to Chronic Venous Disease

Abstract

Identified were characteristics of individuals with skin damage related to chronic venous disease. Patients with chronic venous disease (n = 164) were evaluated with duplex ultrasound imaging and were placed in classes 4, 5, and 6 according to the CEAP classification. Their findings were compared with 100 class 2 controls. The prevalence of deep venous thrombosis was higher in the study group (23.7%) versus controls (5.1%; P < .0001), as was the prevalence of deep, perforator, and combined patterns of disease (P < .0001, P < .0007, and P < .0001). The mean duration of disease in controls 2 was shorter compared with the study group (P = .0019). The prevalence of reflux and obstruction within the study group was higher than in controls (P = .0021). Skin changes accurately reflect severity of chronic venous disease. Superficial and perforator vein reflux is the major cause of disease.

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

“…157,173 Venous duplex ultrasound of the femoral vein may provide indirect evidence of outflow obstruction with monophasic waveforms, loss of respiratory variation in the femoral tracing, or poor augmentation of the signal with distal limb compression. 174 Although the diagnostic accuracy of duplex ultrasound may be improved by performing direct duplex ultrasound examination of iliocaval veins, reliable and reproducible imaging may be limited by body habitus, intestinal gas, and operator variability.…”

“…155,156 Venous duplex ultrasound not only provides diagnostic utility but also will identify patterns of venous disease that may have therapeutic implications. 157,158 Because VLUs are usually associated with multilevel disease affecting the superficial, deep, and perforating veins, better defining these variable patterns of venous disease is critically important before any treatment. Evidence supports that 74% to 93% of all patients with VLUs will have superficial vein involvement, but superficial venous reflux will be isolated in only 17% to 54% of the limbs, the remainder of which will have either isolated or combined associated deep vein incompetence or obstruction or perforator incompetence.…”

Clinical Significant of Standing versus Reversed Trendelenburg Position for the Diagnosis of Lower-Extremity Venous Reflux in the Great Saphenous Vein

“…At least one quarter of patients present with some degree of skin damage among patients with CVD. 3,4 Nonsaphenous vein refl ux is found in at least 1 in 10 patients with CVD, which doubles in patients with recurrent varicose veins. [5][6][7] More importantly all the aforementioned veins have their largest diameter in the standing position and are easier to see.…”

“…2,3 Furthermore, at least one quarter of patients with skin damage (CEAP classes 4-6) have also had a previous deep vein thrombosis. 2,3 Refl ux affecting veins at three levels, superfi cial, perforator, and deep, is mostly found in patients with skin damage. 3,4 Therefore, a more detailed examination in the deep veins should be done.…”

“…2,3 Refl ux affecting veins at three levels, superfi cial, perforator, and deep, is mostly found in patients with skin damage. 3,4 Therefore, a more detailed examination in the deep veins should be done. At least one quarter of patients present with some degree of skin damage among patients with CVD.…”