Recurrent Varicose Veins and Primary Deep Venous Insufficiency: Relationship and Therapeutic Implications

1995 ◽  
Vol 10 (3) ◽  
pp. 98-102 ◽  
Author(s):  
G. Guarnera ◽  
S. Furgiuele ◽  
F. M. Di Paola ◽  
S. Camilli
Keyword(s):  
Venous Insufficiency ◽  
Continuous Wave ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Duplex Ultrasound ◽  
Venous Reflux ◽  
Therapeutic Implications ◽  
Superficial Femoral Vein ◽  
Recurrent Varicose Veins

Objective: Evaluation of the relationship between deep venous insufficiency and recurrent varicose veins (RVV). Design: Retrospective analysis of patients affected by RVV submitted to clinical examination, continuous-wave (CW) Doppler, duplex scanning and descending phlebography in cases of incompetence at groin level. Setting: Department of Vascular Surgery, Istituto Dermopatico dell'Immacolata (IRCCS), Rome. Patients: Two hundred and thirty-nine patients affected by RVV. Main outcome measures: CW Doppler ultrasound, duplex ultrasound imaging and descending phlebography to assess venous incompetence. Results: Doppler examination revealed no reflux at the groin level in 80 limbs. In the remaining 166 limbs, descending phlebography showed a superficial venous reflux in 95 limbs (related to a sapheno-femoral junction recanalization or to an inadequate previous operation) while in 69 (28% of the 246 limbs examined) deep venous reflux was present (superficial femoral vein in 38 cases, profunda femoris vein in seven cases and both veins in 24 cases); in two cases reflux came from the pelvic veins. Conclusions: Our data suggest a possible role of primary deep venous insufficiency in the development of RVV and the value of descending phlebography in the planning of further surgery.

The Role of External Banding Valvuloplasty with the Venocuff in the Treatment of Primary Deep Venous Insufficiency

1994 ◽  
Vol 9 (4) ◽  
pp. 150-153 ◽  
Author(s):  
G. Guarnera ◽  
S. Furgiuele ◽  
S. Camilli
Keyword(s):  
Venous Insufficiency ◽  
Femoral Vein ◽  
Duplex Ultrasound ◽  
Signs And Symptoms ◽  
Venous Reflux ◽  
Superficial Femoral Vein ◽  
Deep Vein ◽  
Correct Size

Objective: Evaluation of the role of external banding valvuloplasty in the treatment of primary deep venous insufficiency. Design: Retrospective analysis of patients subjected to external banding valvuloplasty (EBV) with the Venocuff in relation to the evolution of venous reflux. Setting: Department of Vascular Surgery, Instituto Dermopatico dell'Immacolata, Rome, Italy. Patients: Ten patients with signs and symptoms of chronic venous insufficiency. Interventions: Application of a Venocuff to the superficial femoral vein. Main outcome measures: The correction rate of the primary deep venous reflux assessed by venography and colour duplex ultrasound. Results: In a mean follow-up period of 10 months, deep vein reflux was completely abolished in nine patients (90%). Conclusions: The Venocuff is an improvement over the previous techniques, of surgical treatment of primary deep venous insufficiency in reducing the dilated valve bulb to the correct size in a quick, standardized and precise way.

Lower Limb Deep Venous Incompetence is Rare in Patients Undergoing Obesity Surgery

2000 ◽  
Vol 15 (1) ◽  
pp. 30-32 ◽  
Author(s):  
A. Westling ◽  
A. Boström ◽  
S. Gustavsson ◽  
S. Karacagil ◽  
D. Bergqvist
Keyword(s):  
Lower Limb ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Clinical Signs ◽  
Duplex Ultrasound ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Saphenous Veins ◽  
The Common

Objective: To investigate the incidence of lower limb venous insufficiency in morbidly obese patients. Patients and methods: The study group comprised 125 patients (109 women, 16 men). The median (range) age and body mass index were 35 (19–59) years and 42 (32–68) kg/m2 respectively. Eleven patients had clinical signs of varicose veins or had previously undergone varicose vein surgery. Patients were investigated with duplex ultrasound scanning on the day before surgery. Iliac, femoral, popliteal, and long and short saphenous veins in both legs were studied. Results: A total of 33 patients had abnormal reflux in the superficial veins (>0.5 s). In the deep veins 2 patients had valvular incompetence in the common femoral vein with reflux times of 2 and 0.7 s respectively. At reinvestigation 18 and 24 months after surgery the reflux times were normalised. Conclusion: In this study the incidence of deep venous incompetence in the lower limb in morbidly obese patients is low.

Physical Examination, Doppler Ultrasound and Colour Flow Duplex Scanning: Guides to Therapy for Primary Varicose Veins

1993 ◽  
Vol 8 (1) ◽  
pp. 7-11 ◽  
Author(s):  
R. G. DePalma ◽  
M. T. Hart ◽  
L. Zanin ◽  
E. H. Massarin
Keyword(s):  
Physical Examination ◽  
Continuous Wave ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Clinical Results ◽  
Duplex Scanning ◽  
Predictive Values ◽  
Superficial Femoral Vein ◽  
Colour Flow ◽  
Operative Findings

Objective: To compare physical examination (PE) and continuous-wave hand-held Doppler (CWD) examination with colour flow duplex scanning as a gold standard for greater saphenous vein (GSV) reflux. Design: Prospective performance of PE and CWD by two clinical examiners and subsequent duplex scanning by two vascular laboratory technicians unaware of the results of the PE and CWD examinations. Tapes were then reviewed; results of the duplex scanning were compared with physical and CWD findings. Patients: Thirty-one women and nine men, aged 27–64 years, with symptomatic class I primary varicosities in distribution of the GSV. Eighty limbs were evaluated Prospectively in 40 consecutive patients, including 22 limbs in 14 patients with a history of prior GSV stripping. Interventions: GSV ligation and stripping in 50 limbs when duplex demonstrated saphenofemoral or truncal reflux; 30 limbs were treated by stab avulsion, cluster excision and sclerotherapy. Main outcome measures: Demonstration of saphenofemoral reflux by duplex was confirmed by operative findings. Sensitivity, specificity and positive and negative predictive values of PE and CWD were calculated in comparison to duplex scans. Results: For PE, sensitivity ad specificity were 48% and 73%; positive predictive and negative predictive values were 75% and 46%. For CWD, sensitivity and specificity were 48% and 83%; positive predictive and negative predictive values were 83% and 44%. CWD was falsely positive for saphenofemoral reflux in 10 instances. The GSV was spared in these 10 limbs and in 20 other limbs based on negative colour flow duplex examinations. At 12–18 months clinical results were similar in 50 limbs treated by ligation and GSV stripping as compared with 30 treated by stab avulsion, cluster and sclerotherapy. Conclusion: Sensitivity and negative predictive values for PE and CWD were low while specificity and postitive predictive values were high. CWD false postitives were due to insonation of veins close to the bulb or upper superficial femoral vein reflux subsequently detected by duplex scans. Colour flow duplex scanning is recommended prior to intervention for primary saphenous varicosities; exceptions occur in slender subjects where PE and CWD are more specific and predictive for reflux.

Assessment of Lower Extremity Venous Valvular Insufficiency Examinations

2005 ◽  
Vol 29 (3) ◽  
pp. 123-129 ◽  
Author(s):  
Terry Needham
Keyword(s):  
Lower Extremity ◽  
Ultrasound Imaging ◽  
Continuous Wave ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Venous Hypertension ◽  
Venous Reflux ◽  
Reduced Pressure ◽  
Continuous Wave Doppler ◽  
Valvular Insufficiency

Usually, venous insufficiency affecting an extremity results from elevated pressure, whereas arterial insufficiency usually is caused by reduced pressure energy. Except when caused by arteriovenous fistulae, elevated venous pressures are caused by obstruction to outflow and/or by incompetence of the venous valves, particularly at popliteal level and in the calf perforator veins. In the lower extremity, such elevated venous pressures can result in chronic changes that cause symptoms and/or signs that range from “tired legs” to ulceration. Although mild venous hypertension may constitute only a relative inconvenience such as varicose veins, more severe cases can lead to debilitating ulceration that may demand a change in lifestyle. Assessing an extremity for venous valvular insufficiency means detecting venous reflux. This work describes the plethysmographic, continuous-wave Doppler, and duplex ultrasound imaging modalities that can be used for detecting venous reflux in the deep, superficial, and perforating veins. Although plethysmographic and continuous-wave Doppler modalities have been supplanted largely by duplex ultrasound imaging, they have been included for completeness because they can continue to fulfill a role in overall functional assessment. Whatever the testing modality used to assess venous reflux, it is essential to verify the patency of the deep veins before any intervention in the superficial venous system.

Venous Reflux at the Sapheno-Femoral Junction

1995 ◽  
Vol 10 (4) ◽  
pp. 132-135 ◽  
Author(s):  
G. M. Somjen ◽  
J. Donlan ◽  
J. Hurse ◽  
J. Bartholomew ◽  
A. H. Johnston ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Ultrasound Examination ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Duplex Ultrasound ◽  
Venous Reflux ◽  
Duplex Scan ◽  
Common Femoral Vein ◽  
Long Saphenous Vein ◽  
The Common

Objectives: To clarify reflux patterns in the sapheno-femoral junction in legs with varicose veins that display incompetence in the proximal long saphenous vein on duplex scan examination. Patients and method: One hundred consecutive extremities were selected for ultrasound studies. Venous reflux was examined in the common femoral vein and long saphenous vein at five selected levels in the vicinity of the sapheno-femoral junction. Results: Duplex ultrasound examination confirmed that in 44 extremities reflux was detectable both in the long saphenous vein and common femoral vein indicating ‘true’ sapheno-femoral incompetence. In 56 legs reflux was limited to the long saphenous vein, whilst the first saphenous valve remained competent. The ultrasound examination suggested that in these cases the reflux originated from the numerous tributaries of the proximal long saphenous vein. Conclusion: Our findings emphasize the transfascial escape (reflux from the deep veins) is not a necessary precondition of long saphenous vein incompetence and related varicose veins.

scholarly journals Analysis of a Series of Patients with Varicose Vein Recurrence

2012 ◽  
Vol 40 (3) ◽  
pp. 1156-1165 ◽  
Author(s):  
W Lv ◽  
X-J Wu ◽  
M Collins ◽  
Z-L Han ◽  
X Jin
Keyword(s):  
Varicose Vein ◽  
Surgical Intervention ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Postoperative Recurrence ◽  
Lower Limbs ◽  
Preoperative Imaging ◽  
Superficial Femoral Vein ◽  
Recurrent Varicose Veins ◽  
Imaging Results

OBJECTIVE: Varicose veins of the lower extremities is a common clinical condition. Although surgical treatment is often successful, the recurrence rate remains high. This retrospective study evaluated the reasons for postoperative recurrence of varicose veins by analysing ultrasonography and venography findings in patients with recurrent disease. METHODS: A series of consecutive cases of recurrent varicose veins of the lower limbs was reviewed. Data collected included clinical characteristics, symptoms and vascular imaging. RESULTS: The study included 109 legs with recurrent varicose veins (92 patients): 101/109 legs (92.7%) showed perforating vein insufficiency and 86/109 (78.9%) showed reflux of the superficial femoral vein, of varying degrees of severity. Residual saphenous vein was recorded for 82 legs (75.2%), while 19 (17.4%) had blocked iliac veins due to post-thrombotic syndrome. CONCLUSIONS: Several factors that may contribute to varicose vein recurrence have been identified. These include failure to ligate perforating veins and initial failure to perform the appropriate surgical intervention. Prevention of varicose vein recurrence after surgical correction requires a more extensive use of preoperative imaging, to tailor surgical intervention to suit individual patients.

scholarly journals Quantification of Superficial Venous Reflux by Duplex Ultrasound - Role of Peak Reflux Velocity and Reflux Time in the Assessment of Varicose Vein

2020 ◽  
Vol 18 (3) ◽  
pp. 442-447
Author(s):  
Amit Kumar Singh ◽  
Robin Man Karmacharya ◽  
Satish Vaidya ◽  
Pratima Thapa
Keyword(s):  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Discriminatory Power ◽  
Venous Reflux ◽  
Reflux Time ◽  
Vein Diameter ◽  
And Control ◽  
Superficial Venous Insufficiency

Background: The study compared the peak reflux velocity and reflux time in cases of varicose veins and non-varicose veins with a focus on quantifying the reflux parameters. Methods: This is a hospital based observational comparative study. The limbs with CEAP Clinical classification of C2 or more were taken as diseased limbs and contra-lateral limbs with no symptoms or disease were taken as control limbs. Results: Altogether 792 limbs (452 diseased limbs and 340 control limbs) were evaluated with color duplex. Mean Great Saphenous Vein diameter was 5.68 ± 2.07 mm and 4.00 ± 1.34mmin diseased limbs and control limbs respectively (p=0.0001). Mean sapheno-femoral junction diameter was 8.23 ± 2.64 mm and 6.16 ± 1.93 mm in diseased limbs and control limbs respectively (p=0.0001). Mean peak reflux velocity in diseased limbs was significantly higher than control limbs (77.38 cm/sec vs 7.95 cm/sec; p=0.0001).  Similarly mean reflux time was significantly longer in diseased limbs than non-diseased limb (406.58ms and 67.28 ms respectively; p=0.0001). An optimal cut-off point of 27.4 cm/s for peak reflux velocity and 250 ms for the reflux time at Sapheno-Femoral junction had a discriminatory power between the two groups. Conclusion: The quantification of peak reflux velocity seems to be more consistent than reflux time in determining the superficial venous reflux. An optimal peak reflux velocity cut off point of 27.4 cm/sec has the discriminatory power between diseased and non-diseased limb. Keywords: Peak reflux velocity; reflux time; superficial venous insufficiency; ultrasound color duplex; varicose veins

Non-Thrombotic Deep Venous Incompetence with Special Reference to Anatomic, Haemodynamic and Therapeutic Aspects

1990 ◽  
Vol 5 (4) ◽  
pp. 255-270 ◽  
Author(s):  
Bo Almgren
Keyword(s):  
Venous Insufficiency ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Long Term Results ◽  
Superficial Femoral Vein ◽  
Calf Muscle Pump ◽  
Asymptomatic Patients ◽  
High Incidence

This investigation was undertaken to study non-thrombotic deep venous insufficiency (DVI) in patients with varicose veins or other venous symptoms. Deep venous reflux was observed in 3.5% of the ‘normal’ limbs in patients with unilateral varicose veins. A high incidence of reflux was found in limbs with untreated (21%, P < 0.001) and with recurrent varicose veins (43%, P < 0.001) compared with that in ‘normal’ limbs. Among patients with non-thrombotic DVI the most common patterns were isolated reflux in the superficial femoral vein (51%), and combined reflux in the superficial and deep femoral veins (44%). Isolated reflux in the deep femoral vein occured in 5%. Complete visualization of the deep femoral vein is a new diagnostic sign that strongly correlates ( P < 0.001) with reflux in this vein. femoropopliteal and isolated popliteal reflux caused abnormal venous pressure values even in asymptomatic patients. Incompetence of calf perforators strongly influenced these values. Varicose vein surgery in limbs with a strong calf muscle pump resulted in significant improvement in venous pressure. The long-term results of valvuloplasty were good in 67% of the extremities. A significant improvement in venous pressure was observed in limbs with competent deep femoral vein valves, which suggests that the functional state of this vein is of great haemodynamic importance.

Venous Reflux Localization: Comparative Study of Venography and Duplex Scanning

1993 ◽  
Vol 8 (3) ◽  
pp. 124-127 ◽  
Author(s):  
L. I. Valentín ◽  
W. H. Valentín ◽  
S. Mercado ◽  
C. J. Rosado
Keyword(s):  
Ultrasound Imaging ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Femoral Vein ◽  
Duplex Ultrasound ◽  
Duplex Scanning ◽  
Venous Disease ◽  
Superficial Femoral Vein ◽  
Saphenous Veins ◽  
Prospective Comparison

Objective: To compare the results obtained by duplex ultrasound imaging and ascending and descending phlebography in patients with chronic venous insufficiency. Design: Prospective comparison between venography and duplex ultrasound imaging in a single patient group with chronic venous insufficiency. Setting: Private vascular clinic in Puerto Rico. Patients: Twenty-one patients presenting with clinical evidence of venous disease of the lower limb. Main outcome measures: Presence of valvular incompetence in deep and superficial veins as indicated by duplex ultrasound imaging and ascending and descending phlebography. Results: Duplex ultrasound imaging showed twice as many patients with popliteal vein incompetence (eight veins compared with four veins) and twice as many incompetent long saphenous veins (14 detected by duplex, eight detected by venography). In the proximal venous system, 13 common femoral veins were thought incompetent on venography, but only seven on duplex scanning; in the superficial femoral vein, 11 were incompetent on venography and three on duplex scanning. Conclusion: Duplex ultrasound scanning provides greater sensitivity for detection of valvular incompetence in distal veins compared with venography. Descending phlebography is poor in demonstrating distal venous valvular incompetence.

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