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Primary superficial vein reflux with competent saphenous trunk
N Labropoulos1, S S Kang, M A Mansour
1Division of Vascular Surgery, Loyola University Medical Center, Maywood, IL, USA.
Summary
Reflux in superficial vein tributaries, often overlooked, is prevalent in chronic venous disease (CVD). This isolated tributary reflux, particularly in the greater saphenous vein, is common in lower limbs.
Area of Science:
- Vascular Surgery
- Phlebology
- Venous Diagnostics
Background:
- Superficial vein tributary reflux is frequently underreported, often grouped with main saphenous vein issues.
- Its distinct contribution to chronic venous disease (CVD) signs and symptoms remains under-recognized.
Purpose of the Study:
- To determine the distribution and extent of non-truncal superficial venous reflux.
- To investigate the association between isolated tributary reflux and CVD clinical presentation.
Main Methods:
- Color-flow duplex imaging of 84 limbs in 62 patients with CVD symptoms and Doppler-confirmed reflux.
- Exclusion of patients with saphenous trunk, deep vein, or perforator incompetence, and other complicating factors.
- CEAP classification used for staging CVD severity.
Main Results:
- Isolated tributary reflux was found in 9.7% of limbs, affecting 171 tributaries.
- Greater saphenous vein tributaries were most commonly involved (65%), followed by lesser saphenous (19%).
- The posterior arch vein was the most frequent incompetent tributary (27%); 51% of reflux occurred both above and below the knee.
Conclusions:
- Reflux confined to superficial tributaries occurs throughout the lower limb, independent of saphenous trunk or deep vein incompetence.
- Greater saphenous tributaries are significantly more affected than lesser saphenous tributaries; non-saphenous reflux is rare.
- The majority of affected limbs presented with CVD Class 2 (71%), with 15% in more severe Classes 3 and 4.