Therapeutic implications of phlebographic obstruction in chronic venous stasis

The purpose of this work was to evaluate the functional characteristics of the venous system of patients with chronic obstruction of their deep veins proved by phlebography. Sixty-eight extremities in 34 normal volunteers and 21 extremities in 17 patients with chronic venous stasis and phlebographically demonstrated obstruction of their deep veins (popliteal-superficial femoral in 33.3%, common femoral in 23.8%, iliac in 33.3% and inferior vena cava in 9.5%) were evaluated using mercury in silastic strain gauges on the feet to measure venous volume changes on elevation and exercise. Regurgitant flow, corrected for arterial foot blood flow, was calculated. In the control group, the apparent regurgitation range was 0 to 2.3 ml %/min (mean +/- 2 SD). Sixty-two percent of extremities with obstructed deep veins had significant functional regurgitation. Regurgitation was detected by phlebography in only 14.3% of cases. From these results we conclude that obstruction of the deep venous system by phlebography may or may not signify functional obstruction and, in itself, therefore, does not indicate that bypass surgery is an appropriate method of treatment. Selection for surgical correction requires quantitative determination of insufficiency since higher grades of regurgitation probably contraindicate venous bypass.