Patterns of Venous Reflux in 1,027 Lower Limbs with Primary Varicose Veins

Abstract

Objective The purpose of this study was to investigate the anatomical patterns of superficial venous reflux in patients presenting with primary varicose veins. Methods Ultrasound scans, detailed vein maps, and histories of patients presenting to a single vein center were retrospectively reviewed. Patients included in the study were those presenting with primary varicose veins and classified as clinical, etiologic, anatomic, and pathophysiologic classes 2 through 4. Patients with histories of venous intervention, malformations, active ulcerations, or deep system abnormalities were excluded from this study. Results Overall, 1,027 limbs of 617 patients met the inclusion criterion. The male to female ratio was 1:6.0. Varicose veins were attributed to reflux in the great saphenous vein (GSV) 66% (n = 679) of the time. When GSV reflux was present, the saphenofemoral junction was incompetent 83% of the time. Six percent of varicose veins were attributed to the anterior accessory saphenous vein. Small saphenous vein (SSV) reflux was demonstrated in 34.8% (n = 357). The thigh extension of the SSV and vein of Giacomini demonstrated reflux in 7% (n = 69) and 1% (n = 15) of limbs, respectively. Reflux of nonsaphenous origin was present in 19% (n = 198) of limbs (isolated tributary reflux). Conclusion The variations of superficial venous reflux in patients presenting with primary varicose veins are diverse and complex. Therefore, thorough duplex ultrasound is necessary in all patients with primary varicose veins to evaluate the precise source of reflux to determine therapeutic options.

Risk Factors for Bleeding Varicose Veins in Patients with Chronic Venous Disease

“…The main sites of superficial venous system of lower limbs that can be involved in CVD pathophysiology and vein reflux are represented by GSV, small saphenous veins (SSV), anterior accessory saphenous veins (AASVs), SFJ, sapheno-popliteal junction (SPJ), perforators veins, and non-saphenous veins [ 12 ]. In particular, the superficial veins connect to the deep veins at the SFJ, where the GSV joins the common femoral vein, and at the SPJ where the SSV joins the popliteal vein [ 13 ].…”

Saphenous reflux patterns in C2 patients: A record of 1196 ultrasound reports

“…15 Carrison et al used vascular ultrasonography to study 1027 limbs from 617 patients classified as classes C2, 3, or 4 on the CEAP classification, finding rates of GSV and SSV reflux of 66 and 35%, respectively. 16 Qureshi et al published their ultrasound evaluation of 2559 limbs with CVI. 17 The most common pattern of primary GSV disease was the combination of SFJ incompetence with GSV reflux above and below the knee.…”