Duplex scanning and light reflection rheography in the assessment of the severity of short saphenous vein incompetence

Presentation of the patient with recurrent varices after surgery (REVAS)

AIM

To identify in patients with recurrent varices after surgery (REVAS) the clinical, etiologic, anatomic, and pathophysiologic patterns according to the CEAP classification, as well as the site, source, causes of recurrence, and contributory factors by using the REVAS classification.

METHODS

Centers from eight countries enrolled patients with superficial vein reflux that had had a previous operation. A physical examination and a duplex ultrasound scan were performed at the first visit. This was repeated between 2 to 8 weeks after by the same physician and by another physician within the same time frame. The perforator, deep, and superficial veins systems as well as their accessories and tributaries were examined. A form based on the CEAP and the REVAS classification was used and the data were entered in a customized database.

RESULTS

Fourteen institutions enrolled 170 patients (199 lower limbs) in 1 year. Their mean age was 56 years, and 69% were women. Most of them had undergone one surgical procedure before enrollment (76.6%). Most had varicose veins and swelling (70.9%), and the rest had skin damage (29.1%). More than 90% had primary etiology. The saphenofemoral junction (47.2%) and leg perforators (54.7%) were the areas most often involved by recurrent reflux. Reflux in deep veins was detected in 27.4%. Class 2 (varicose veins) alone was present in 24.6% of limbs, two classes were present in 43%, and three in 24%. Neovascularization was as frequent as technical failure (20% vs 19%); both were seen in 17%. In 35%, the cause was uncertain or unknown. When recurrence occurred at a different site, development of reflux in new sites was found in 32% of limbs. Of the contributing factors, family history and lifestyle had the highest prevalence. Women had significantly more procedures than men, despite a clear trend toward more severe disease in the latter.

CONCLUSIONS

Most patients were symptomatic with several clinical forms of presentation. The REVAS classification, together with CEAP, gives significant and more appropriate information for evaluating and following-up patients with chronic venous disease who have had an intervention.

Lateral venous ulcer and short saphenous vein insufficiency

PURPOSE

The objective of this report is to emphasize the importance of saphenopopliteal junction (SPJ) reflux in the genesis of lateral leg ulcers and to suggest a proper diagnostic and therapeutic approach.

METHODS

Twenty legs with isolated lateral perimalleolar ulcers from the basis for this report. None had medial ankle ulcers, and most showed no hyperpigmentation or lipodermatosclerosis. Fifteen had been treated with a nonvenous diagnosis. Reflux at the SPJ was detected by handheld continuous wave Doppler and was confirmed with duplex scans. No other abnormalities were found. Brief conservative treatment and duplex localization of the SPJ preceded its ligation and division.

RESULTS

All ulcers healed within 12 weeks, but one in a radiated leg recurred at 9 months. Other complications included two hematomas and one each of ankle edema, superficial wound infection, and sural neuropathy.

CONCLUSIONS

Even isolated lateral leg and ankle ulcers with minimal accessory venous stigmata can be of venous reflux origin. Detection with the continuous wave Doppler and confirmation of reflux and localization of the SPJ allow surgical correction to proceed swiftly with an expectation of satisfactory results.

Duplex examination

BACKGROUND

Accurate venous diagnosis remains a challenge for the phlebologist and vascular laboratory. In recent years duplex ultrasound has become the preferred method of diagnosis for deep venous thrombosis and deep and superficial venous insufficiency.

OBJECTIVE

To describe the physical principles, typical protocol, and indications for venous duplex examination.

CONCLUSION

Duplex examination offers a precise, noninvasive technique to make anatomic and functional venous diagnoses.

Anatomy of the superficial venous system

BACKGROUND

A number of informative and detailed scientific communications have been published in recent years on the functional anatomy of the lower extremity venous system.

OBJECTIVE

This paper is aimed at providing basic anatomic information for physicians interested in phlebology. It also highlights the new research areas and the changing concepts on the the pathophysiology of varicose veins.

METHODS

The material is concentrated on observations made during duplex scan examination of the venous drainage of normal and abnormal limbs.

RESULTS

The etiology and classification of varicose veins are discussed, followed by a description of the subcutaneous venous anatomy based upon ultrasound studies. The anatomy of venous reflux in different segments of the superficial venous system is examined in the light of recent duplex ultrasound findings.

CONCLUSION

The presentation and treatment of varicose veins may vary depending on the anatomical distribution of valvular incompetence.