[Vertical reflux in lower-limb varicosity: variants, diagnosis, treatment]

Based on thoroughly analysing the findings obtained by ultrasonographic duplex scanning performed on a total of 763 lower limbs in 547 people presenting with various-pattern and different-localization dilatations of the saphenous veins, the author has herein managed to determine that nearly 20% of the examined patients turned out to have no retrograde regurgitation of the blood flow along the vessels concerned, and that in a further 7.3% of the patients, the backward flow of blood appeared to have no communication with the subfascial venous system. To put it otherwise, a vertical reflux in its classical manifestation is not always observed in the presence of the dilated superficial veins of the lower extremities. It turned out that a vertical reflux may be secondary to or result from not only valvular incompetence of the saphenofemoral and saphenopopliteal junctions, which certainly is the case in terms of the perception so deeply rooted in our minds, as a conventionally and rather reasonably considered source of origin, but may also be a consequence of the incompetent venae perforantes of Dodd and those of lateral localization, as well as the communications with the pelvic veins. Amongst the peculiar features encountered herein and worth mentioning was the fact that the vertical reflux could propagate both along the trunk of the great and/or small saphenous veins and along their tributaries only, involving either a part of, or the entire venous vessel all along its length. The obtained findings were later positively reflected in therapeutic decision-making and favourably contributed to carefully assigning and duly delivering appropriate treatment to have eventually consisted in minimally invasive interventions and organ-sparing procedures.