Abstract
Objective: Duplex scanning readily identifies typical proximal venous reflux that descends directly to varices. Occasionally, reflux may first descend in a saphenous or deep vein, and then reverse direction to ascend 10 cm or more in a tributary or varicose vein before descending again to clinically evident varicose veins. This pattern, here defined as roller coaster reflux (RCR), can be difficult to establish, since no immediate superior source of reflux feeds the uppermost varices. This study reviews recent clinical experience with RCR and illustrates the phenomenon in two patients.
Methods: Over a two-year period in a solo phlebology practice, duplex ultrasound was used on patients with varicose veins to identify the initial descending reflux and the point of reversal where flow began to ascend. A Trendelenburg manoeuvre with direct compression over the point of reversal was used to prove whether the source of venous distention lay 10 cm or more below the most superior varices.
Results: A total of 12 patients showed evidence of RCR with flow ascending 10-23 cm to feed the uppermost varices. The sources of descending reflux were the femoral (3), popliteal (2), great saphenous (4), short saphenous (2) and tibial (1) veins. The ascending veins were the great saphenous (3), Giacomini (2) or varices (7). Elimination of the source of reflux along with the varices routinely resulted in clinical success.
Conclusions: Roller coaster reflux should be sought in individuals whose reflux does not appear to arise from a superior source.
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