To determine the distribution patterns of pathological venous reflux and risk factors in patients with skin changes due to primary venous disease.
Methods
Two hundred limbs belonging to C4, C5 & C6 classes were examined with duplex ultrasound to determine the sites of reflux. We also analyzed the correlation of risk factors with patterns and severity of disease.
Results
Among 200 limbs, superficial system reflux was found in 163 limbs (81.5%), deep system reflux in 10 limbs (5%) and perforator system reflux in 180 limbs (90%). The most common pattern of abnormality was combined superficial and perforator system reflux. Of all the risk factors, prolonged standing, obesity and in the female history of pregnancy preceding varicose occurrence had the highest prevalence.
Conclusions
In patients with primary chronic venous disease, lifestyle modification is required to avoid risk associated with obesity and prolonged standing. The higher prevalence of pathological perforator reflux in association with advanced venous disease necessitates careful treatment of this least reported pathology to achieve better treatment results.
CallamMJRuckleyCVHarperDR, et al.
Chronic ulceration of the leg: extent of the problem and provision of care.Br Med J1985;
290: 1855–1856.
3.
NicolaidesABerganJJEklofB, et al. Classification and grading of chronic venous disease in the lower limbs: a consensus statement. In: GloviczkiPJSTYao (eds) Handbook of venous disorders: guidelines of the American Venous Forum.
London:
Chapman & Hall Medical, 1996, pp. 652–660.
4.
EklöfBRutherfordRBBerganJJ, et al.
Revision of the CEAP classification for chronic venous disorders: consensus statement.J Vasc Surg2004;
40: 1248–1252.
5.
LabropoulosNMansourMAKangSS, et al.
New insights into perforator vein incompetence. Eur J Vasc Endovasc Surg1999;
18: 228–234.
6.
GloviczkiP, et al.
The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the society for vascular surgery and the American Venous Forum.J Vasc Surg2011;
53: 2S–48S.
7.
LabropoulosNPatelPJTiongsonJE, et al.
Patterns of venous reflux and obstruction in patients with skin damage due to chronic venous disease. Vasc Endovascular Surg2007;
41: 33–40.
8.
LabropoulosNGiannoukasADNicolaidesAN, et al.
The role of venous reflux and calf muscle pump function in non-thrombotic chronic venous insufficiency. Correlation with severity of signs and symptoms. Arch Surg1996;
131: 403–406.
9.
ChristopoulosDNicolaidesANCookA, et al.
Pathogenesis of venous ulceration in relation to the calf muscle pump function.Surgery1989;
106: 829–835.
10.
SkeneAISmithJMDoréCJ, et al.
Venous leg ulcers: a prognostic index to predict time to healing.Br Med J1992;
305: 1119–1121.
11.
FranksPJBosanquetNConnollyM, et al.
Venous ulcer healing: effect of socioeconomic factors in London.J Epidemiol Community Health1995;
49: 385–388.
12.
BakerSRStaceyMCJopp-McKayAG, et al.
Epidemiology of chronic venous ulcers.Br J Surg1991;
78: 864–867.
13.
IoannouCVGiannoukasADKostasT, et al.
Patterns of venous reflux in limbs with venous ulcers: implications for treatment. Int Angiol2003;
22: 182–187.
14.
PadbergFJrCerveiraJJLalBK, et al.
Does severe venous insufficiency have a different etiology in the morbidly obese? Is it venous?J Vasc Surg2003;
37: 79–85.
15.
García-GimenoMRodríguez-CamareroSTagarro-VillalbaS, et al.
Reflux patterns and risk factors of primary varicose veins’ clinical severity.Phlebology2013;
28: 153–161.
16.
BoivinPCornu-ThenardACharpakY.Pregnancy-induced changes in lower extremity superficial veins: an ultrasound scan study. J Vasc Surg2000;
32: 570–574.
17.
CriquiMHDenenbergJOBerganJ, et al.
Risk factors for chronic venous disease: the San Diego population study.J Vasc Surg2007;
46: 331–337.
18.
UhlJFChahimMAllaertFA.Static foot disorders: a major risk factor for chronic venous disease?Phlebology2012;
27: 13–18.
19.
TassiopoulosAKGoltsEOhDS, et al.
Current concepts in chronic venous ulceration. Eur J Vasc Endovasc Surg2000;
20: 227–232.
20.
KatsamourisANKardoulasDGGourtsoyiannisN.The nature of lower extremity venous insufficiency in patients with primary varicose veins. Eur J Vasc Surg1994;
8: 464–471.
21.
BurnandKGO'DonnellTFJrThomasML, et al.
The relative importance of incompetent communicating veins in the production of varicose veins and venous ulcers. Surgery1977;
82: 9–14.
22.
BjordalR.Flow and pressure studies in venous insufficiency. Acta Chir Scand Suppl1988;
544: 30–33.
23.
StaceyMCBurnandKGLayerGT, et al.
Calf pump function in patients with healed venous ulcers is not improved by surgery to the communicating veins or by elastic stockings.Br J Surg1988;
75: 436–439.
24.
HanrahanLMArakiCTRodriguezAA, et al.
Distribution of valvular incompetence in patients with venous stasis ulceration. J Vasc Surg1991;
3: 805–812.
25.
ZukowskiAJNicolaidesANSzendroG, et al.
Haemodynamic significance of incompetent calf perforating veins.Br J Surg1991;
78: 625–629.
26.
GloviczkiPBerganJJRhodesJM, et al.
Mid-term results of endoscopic perforator vein interruption for chronic venous insufficiency: lessons learned from the North American subfascial endoscopic perforator surgery registry. The North American Study Group. J Vasc Surg1999;
29: 489–502.
27.
PierikEGvan UrkHWittensCH.Efficacy of subfascial endoscopy in eradicating perforating veins of the lower leg and its relation with venous ulcer healing. J Vasc Surg1997;
26: 255–259.
28.
LabropoulosNDelisKNicoladesAN, et al.
The role of the distribution and anatomic extent of reflux in the development of signs and symptoms in chronic venous insufficiency. J Vasc Surg1996;
23: 504–510.
29.
DelisKT.Perforator vein incompetence in chronic venous disease: a multivariate regression analysis model. J Vasc Surg2004;
40: 626–633.
30.
LabropoulosNLeonMGeroulakosG, et al.
Venous hemodynamic abnormalities in patients with leg ulceration. Am J Surg1995;
169: 572–574.
