Deep venous reflux definitions and associated clinical and physiological significance

• Published in: Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) NY), 2013-10, Vol.1 (4), p.325-332
• Main Authors: Lim, Kah Heng, MB ChB, BMed Sc (HONS), Hill, Gerry, MSc, Tarr, Greg, MB ChB, PhD, van Rij, Andre, MD, FRACS
• Format: Article
• Language: English
• Subjects: Surgery
• ISSN: 2213-333X
• DOI: 10.1016/j.jvsv.2012.12.003

Background Deep venous reflux (DVR) is often a poorly defined clinical entity. The extent of DVR that must occur for it to be clinically and hemodynamically important is not clear and is usually confounded by the presence of superficial venous reflux. This study aims to investigate the effect of the extent of DVR on clinical and hemodynamic parameters while controlling for the presence of superficial reflux. Methods We performed a cross-sectional study, using a prospectively designed data set obtained from patients presenting to a vascular laboratory for lower limb venous assessment. Age, gender, duplex ultrasound assessment of the deep and superficial systems, CEAP clinical class, and venous filling index (VFI) measurements were obtained. A classification of axial DVR is described, based on the level of continuous reflux occurring in the vertical axis as detected by duplex ultrasound: axial 0 (no deep reflux), axial 1 (common femoral vein only), axial 2 (to any level of the femoral vein), axial 3 (to the level of the popliteal vein), and axial 4 (into the calf veins) A subset of segmental reflux is also defined. Results This study included 3122 limbs from 2349 subjects. Limbs with increasing axial level were more likely to have CEAP 4-6 (axial 0: 294 [37.2%]; axial 1: 520 [41.6%]; axial 2: 82 [41.2%]; axial 3: 92 [59.7%]; axial 4: 148 [64.9%], P value for trend