Incompetent perforating veins are associated with recurrent varicose veins. (65/708)

AIMS: we suspected incompetent perforating veins of having a role in the development of recurrent varicose veins in some patients. The aim was to look for an association between perforators and recurrent varicose veins. METHODS: a consecutive group of patients presenting with varicose veins were examined using colour duplex ultrasonography by an experienced vascular technologist. Pathological perforating veins were defined as those exhibiting bi-directional flow and a diameter of 4 mm or greater at the fascia. RESULTS: between September 1998 and July 1999, 204 patients were examined. Primary varicose veins were found in 198 legs (135 patients) and recurrent varicose veins in 91 legs (69 patients). In patients with primary varicose veins, 88 (44%) had incompetent perforators compared to 57 (63%) of those with recurrent varicose veins (Chi-squared, p <0.005). Also, for recurrent varicose veins, the percentage of patients with any given number of incompetent perforators was higher than for primary varicose veins. Overall, there was a higher number of incompetent perforators in those with recurrent veins compared to primary veins and this difference was significant at 95% confidence interval. CONCLUSION: patients with recurrent varicose veins have both a higher prevalence and a greater number of incompetent perforating veins than patients with primary varicose veins.  (+info)

The role of popliteal vein incompetence in the diagnosis of saphenous-popliteal reflux using continuous wave doppler. (66/708)

INTRODUCTION: continuous wave Doppler (CWD) has good discriminatory power at the groin in the assessment of saphenous femoral junction (SFJ); however, it is not as accurate as duplex ultrasound scanning (DUS) in the popliteal fossa for assessment of saphenous popliteal junction (SPJ) in patients with primary short saphenous vein incompetence. AIM: the aim of this study was to compare the findings of CWD with those of DUS at the SPJ and assess the role of popliteal vein incompetence in the accuracy of CWD. METHOD: prospective study of consecutive patients presenting to a vein clinic requiring a duplex scan of their SPJ. Each patient was examined by one surgeon using CWD and by one radiologist using DUS. Each observer was unaware of the other's findings. Additional information on the competence of the popliteal vein on DUS was also recorded. RESULTS: some 171 limbs in 128 patients with varicose veins were studied. One hundred and sixteen limbs had reflux at SPJ on CWD whilst 55 did not. Their mean age was 54 (range 18-85). Female to male ratio was 3:1. Spearman's rank correlation between CWD and DUS has 0.49 (p =0.0001). CWD has a sensitivity of 92% and specificity of 53% (PPV=62%, NPV=89%, accuracy=70%). Twenty-nine limbs had an incompetent popliteal vein (IPV). Of those, 12 limbs also had incompetence on CWD and competence on DUS at the SPJ, which represent 28% of the total number of limbs with these findings (n =43). CONCLUSION: CWD is sensitive in detecting incompetence at SPJ, though its specificity is low. In this study 17% (n =29) of all patients had incompetence of popliteal vein. Up to 25% ( n =12) of patients with SPJ incompetence on CWD (Doppler +) and competence on DUS (duplex -) had incompetence of the underlying popliteal vein, which may explain the low specificity. The presence of SPJ incompetence on CWD should be confirmed on DUS prior to surgery.  (+info)

Preoperative assessment of primary varicose veins: a duplex study of venous incompetence. (67/708)

OBJECTIVES: we investigated the importance of preoperative duplex scanning in primary uncomplicated varicose vein surgery by evaluating the incidence of superficial venous imcompetence and significant anatomical variations that may be difficult to detect clinically and therefore might be expected to contribute to recurrence. DESIGN: a retrospective study of a prospectively collected database. MATERIALS: over 15 consecutive months, patients attending the non-invasive vascular laboratory for duplex scanning of their primary uncomplicated varicose veins were assessed. METHODS: vascular laboratory case notes were assessed and incidence of superficial venous incompetence and any significant anatomical variations that would have been difficult to detect clinically +/-HHD were documented. Any correlation with clinical findings was also evaluated. RESULTS: a total of 223 limbs (176 patients) were assessed. Sixty-seven limbs (30%) in fact had a competent sapheno-femoral junction. Sixty-one limbs (27%) had pure sapheno-femoral reflux and nil else. Fifty-three limbs (24%) had significant anatomical variations. Forty-two limbs (19%) had short saphenous vein incompetence, of which 67% were clinically unsuspected. CONCLUSIONS: preoperative duplex scanning is indicated in all patients with uncomplicated primary varicose veins if appropriate venous surgery is contemplated. There are obvious resource and recurrence rate implications. Further evaluation in the form of randomised trials are required.  (+info)

Three-dimensional contrastless varicography by spiral computed tomography. (68/708)

OBJECTIVE: to report and discuss preliminary results obtained in varicose limbs by means of a volume rendering (VR)-computed tomography (CT) technique without contrast medium injection. MATERIALS AND METHODS: VR-CT and duplex sonography (US) were performed to visualise the superficial veins of the lower extremity in eight healthy and 12 varicose limbs. RESULTS: VR-CT clearly demonstrated the 3D arrangement of the superficial veins and visualised small sized veins which were not visible at US examination. CONCLUSIONS: VR-CT is not suitable for routine evaluation of varicose limbs. VR-CT 3D reconstructions may be useful in the evaluation of atypical varicosis. Further studies are needed to define the role of VR-CT in deep venous disease.  (+info)

Long saphenous vein stripping and quality of life--a randomised trial. (69/708)

OBJECTIVES: To assess the quality of life of patients undergoing sapheno-femoral junction (SFJ) ligation and long saphenous vein stripping (LSV), using two different techniques. DESIGN: Prospective, randomised trial. MATERIALS AND METHODS: Eighty patients were recruited and randomised to either Perforate Invagination (PIN) stripping (43) or Conventional stripping (37). Patients completed the Short Form 36 (SF-36) and EuroQol (EQ) questionnaires preoperatively, and postoperatively at 6 weeks and 6 months. RESULTS: Bodily pain, role function and physical summary were significantly improved at 6 months in the PIN stripping group. In the Conventional group, bodily pain and physical function were similarly improved, but not role function. EQ global quality of life was significantly and progressively improved at 6 weeks and 6 months in the PIN group (global score p<0.003; self-rated score p <0.001). In the Conventional group there was no overall improvement in global score or self-rated health. CONCLUSIONS: Primary varicose vein surgery is associated with significant and progressive improvements in quality of life scores. Whilst overall quality of health does improve in the Conventional group, this appears to be to a lesser extent than in the PIN group.  (+info)

Non-saphenofemoral venous reflux in the groin in patients with varicose veins. (70/708)

OBJECTIVES: To investigate the incidence, clinical significance, anatomical variation and physiology of non-saphenofemoral venous reflux (non-SF reflux) in the groin. DESIGN: Prospective study. MATERIALS: A total of 1072 vascular diagnostic workups in 680 patients with possible venous diseases to the legs were included. METHODS: Duplex scanning and air plethysmography. RESULTS: A total of 1022 legs had venous diseases. Of these, 101 (9.9%) had non-SF reflux in the groin. Such reflux occurred in recurrent varicose veins (RVV) in 16.3%, in primary varicose veins (PVV) in 6.1% and in deep venous thrombosis (DVT) in 8.0%. Two patterns of reflux were distinguished: epigastric reflux from lower abdominal wall veins (71 legs) and pudendal reflux from perineal and/or gluteal veins (30 legs). Pudendal reflux was almost exclusive to women and did not occur with DVT. If there was only non-SF reflux at the groin the venous filling indices (VFI) were close to normal (1.7+/-1.0 ml/s for RVV, 1.9+/-1.2 for PVV, 1.7+/-1.0 for DVT) and no active ulcers were observed. However, if non-SF reflux was associated with saphenofemoral or other reflux the VFIs (3.3+/-2.3 ml/s for RVV, 3.8+/-1.5 ml/s for PVV) were abnormal (p <0.05) and ulcers occurred in 11/32. CONCLUSION: Non-SF reflux in the groin is common. Such reflux may be missed at initial surgery and lead to recurrence of varicose veins. However, the venous physiological disturbance of such reflux is mild and it is not associated with ulcers unless combined with reflux at other sites in the leg.  (+info)

Late recurrent saphenofemoral junction reflux after ligation and stripping of the greater saphenous vein. (71/708)

OBJECTIVE: This study was done to determine the long-term incidence of refluxing epifascial-to-deep vein reconnections in the area of the former saphenofemoral junction after ligation of the true junction, along with all proximal tributaries, and resection of the greater saphenous vein. PATIENTS AND METHODS: A total of 125 limbs in 77 patients, representing 66% of 117 survivors among 602 patients who underwent operation between 1960 and 1967, were evaluated clinically and with duplex sonography for possible superficial-to-deep vein reconnections and clinical recurrence of thigh varicosities at a mean follow-up of 34 years. RESULTS: Clinical examination suggested saphenofemoral recurrence in 59 limbs (47%). In 11 instances these were actually varices associated with isolated superficial system reflux or reflux originating from a distally located perforating vein. Color-coded duplex ultrasonography demonstrated saphenofemoral reflux in 75 limbs (60%), versus the 48 identified on clinical examination (P <.001), and documented that the junction ligation had not been performed incorrectly by absence of the terminal valve or any patent proximal saphenous remnant. The reflux originated at the site of the ligated saphenofemoral junction in 53 limbs (71%) and from a nearby circumjunctional deep vein in the other 22 (29%). Of the real junctional recurrences, 22 appeared as a tangled cluster, and 31 involved a single-lumen varix. Only 27 recurrences were sufficiently symptomatic to warrant consideration of additional treatment; 25 of these were clinically evident, single-lumen, true junctional recurrences. CONCLUSIONS: This 34-year clinical follow-up study shows a 60% incidence of junctional and circumjunctional reconnections after ligation of the true saphenofemoral junction and its related tributaries. Color-coded duplex sonography is a necessary concomitant to clinical examination, detecting more recurrences and defining the pathologic anatomy to direct clinically indicated additional treatments.  (+info)

Lifestyle risk factors for lower limb venous reflux in the general population: Edinburgh Vein Study. (72/708)

BACKGROUND: Varicose veins occur commonly in the general population but the aetiology is not well established. Varicosities are associated frequently with reflux of blood in the leg veins due to valvular incompetence. Our aim was to determine in the general population which lifestyle factors were related to reflux and thus implicated in the aetiology of varicose veins. METHODS: In the Edinburgh Vein Study, 1566 men and women aged 18-64 years were sampled randomly from the general population in the city of Edinburgh, Scotland, and had duplex scans to measure reflux in eight venous segments in each leg. A self-administered questionnaire enquired about occupation, mobility at work, smoking, obstetric history, dietary fibre intake and bowel habit. A bowel record form was completed subsequently. RESULTS: In women, venous reflux was associated with decreased sitting at work (odds ratio [OR] = 0.76, 95% CI : 0.61-0.94), previous pregnancy (OR = 1.20, 95% CI : 0.93-1.54), and a lower prior use of oral contraceptives (OR = 0.84, 95% CI : 0.66-1.06). Mean body mass index was greater in women with superficial reflux compared to those with no reflux: 26.2 kg/m(2) (95% CI : 25.5-27.0) versus 25.2 kg/m(2) (95% CI : 24.8-25.6). On age adjustment, sitting at work remained related to reflux (OR = 0.78, 95% CI : 0.63-0.98) and prior use of oral contraceptives to superficial reflux (OR = 0.71, 95% CI : 0.50-1.01). In age-adjusted analyses in men, height was related to reflux, (OR = 1.13, 95% CI : 1.02-1.26) and straining at stool was related to superficial reflux (OR = 1.94, 95% CI : 1.12-3.35). No associations were found in either sex between reflux and social class, lifetime cigarette consumption, dietary fibre intake and intestinal transit time. CONCLUSIONS: This population study did not identify strong and consistent lifestyle risk factors for venous reflux although previous pregnancy, lower use of oral contraceptives, obesity and mobility at work in women and height and straining at stool in men may be implicated.  (+info)