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Phlebographic evaluation of nonthrombotic deep venous incompetence: new anatomic and functional aspects
B Almgren1, I Eriksson, H Bylund
1Department of Surgery, University Hospital, Uppsala, Sweden.
Insights
Deep venous incompetence in the legs often involves reflux in the superficial femoral vein. Complete visualization of the deep femoral vein during phlebography is a new indicator of reflux.
Area of Science:
- Vascular Surgery
- Phlebology
- Diagnostic Imaging
Background:
- Deep venous incompetence (DVI) is a common condition affecting lower extremities.
- Understanding reflux patterns is crucial for diagnosing and managing DVI.
- Nonthrombotic DVI requires detailed anatomical and functional assessment.
Purpose of the Study:
- To investigate deep vein anatomy, valvular function, and reflux patterns in nonthrombotic DVI.
- To identify new diagnostic signs for deep venous reflux.
- To propose a grading system for deep femoral vein reflux.
Main Methods:
- Ascending and descending phlebography performed on 126 lower extremities with nonthrombotic DVI.
- Analysis of reflux patterns in superficial femoral vein (SFV) and deep femoral vein (DFV).
- Correlation of deep femoral vein visualization with reflux presence and assessment of valve count and vein diameter.
Main Results:
- Isolated SFV reflux (51%) and combined SFV/DFV reflux (44%) were most common.
- Isolated DFV reflux occurred in 5% of cases.
- Complete DFV visualization during ascending phlebography strongly correlated with DFV reflux (p < 0.001).
- Reduced SFV valve count and increased popliteal vein diameter were associated with pathologic reflux.
Conclusions:
- Phlebographic visualization of the DFV is a novel diagnostic marker for DFV reflux.
- Vein wall dilation, particularly of the popliteal vein, may contribute to primary nonthrombotic DVI.
- A grading system for DFV reflux based on anatomical variations was proposed.
Abstract:
The anatomy, valvular function, and reflux patterns in the deep veins of the lower extremities were studied by ascending and descending phlebography in 126 limbs with nonthrombotic deep venous incompetence. The most common patterns were isolated reflux in the superficial femoral vein (51%), and combined reflux in the superficial femoral and the deep femoral veins (44%). Isolated deep femoral vein reflux occurred in 5%. As the degree of reflux in this vein varied considerably, a grading system for classification of deep femoral vein reflux was proposed. Depending on variations in the deep femoral vein anatomy, four different patterns could be distinguished. This study demonstrated that contrast filling of the deep femoral vein during ascending phlebography may indicate the presence of reflux in this vein. Complete visualization of the deep femoral vein is a new diagnostic sign that strongly correlates (p less than 0.001) with reflux in the deep femoral vein. The mean number of valves in the superficial femoral vein was reduced with increasing degree of reflux compared with a reference group consisting of 41 extremities without reflux. The diameter of the popliteal vein was significantly increased in the presence of pathologic reflux, which may indicate that vein wall dilation is a major cause of primary nonthrombotic deep venous incompetence.