Print this pageCorrelation of superficial venous anatomy and reflux with clinical severity: what have we learned through routine duplex surveillance during the endovenous era?
Hung B. Chu, MD, Ahmad Bhatti, MD, Nicos Labropoulos, MD, Kyle Hazelwood, Márcio Barros, MD, Salomon Amaral, MD and Peter G. Kalman, MD
Vascular Surgery, Loyola University Medical Center, Maywood, IL
Objectives:
Accurate duplex imaging of the superficial venous system is essential for optimal patient selection for endovenous greater saphenous vein (GSV) ablation. The objectives of this study were to correlate with clinical severity 1) the GSV diameter and presence of reflux, 2) the length and number of GSV segments with reflux, and 3) to determine the contribution of accessory vein reflux.
Methods:
856 limbs (428 patients) with chronic venous insufficiency were stratified according to their CEAP classification. Color duplex scans were performed detailing the superficial venous anatomy, GSV diameter and presence or absence of reflux in the standing and supine positions. This was assess at the saphenofemoral junction, at the upper, mid and lower thigh, the knee level, and at the upper, mid and lower calf segments. Presence of reflux was also determined in GSV accessory vein segments.
Results:
The diameter of all GCV segments with reflux were significantly larger than those segments without reflux (t-test, p<0.001). GSV diameter within all of the segments correlated directly with clinical severity (ANOVA, p<0.01). GSV accessory vein reflux was the predominant finding in 19.3% of symptomatic extremities and correlated with the CEAP classification (χ2, p<0.001). In patients with GSV reflux alone (81.7%), the length and number of GSV segments with reflux correlated significantly with clinical severity (χ2, p<0.001).
Conclusions:
In this prospective study we have demonstrated that there are measurable duplex findings of the superficial venous system that positively correlate with the CEAP classification. GSV diameter and the number of GSV segments with reflux correlates with clinical severity, as does the presence of isolated accessory vein reflux. These observations provide a useful tool for selection of patients for GSV endovenous ablation.