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Updated: Apr 14, 2026
08:05
Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane
Published on: December 9, 2022
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Descending phlebography in patients with venous ulceration: hemodynamic implications
K G Papadakis1, D Christopoulos, J T Hobbs
1Irvine Laboratory, Academic Surgical Unit, St Mary's Hospital Medical School, London, UK - anicolaides1@gmail.com.
Summary
Popliteal valve incompetence significantly increases ambulatory venous pressure (AVP) in patients with venous ulceration. Superficial venous reflux alone has minimal hemodynamic impact, highlighting the critical role of popliteal reflux in venous hypertension.
Area of Science:
- Vascular Surgery
- Phlebology
- Hemodynamics
Background:
- Venous ulceration is often linked to venous reflux and hypertension.
- The specific contribution of different reflux sites to hemodynamic abnormalities requires clarification.
Purpose of the Study:
- To assess the hemodynamic significance of various reflux degrees using descending phlebography.
- To correlate phlebographic findings with ambulatory venous pressure (AVP) measurements.
Main Methods:
- Thirty-two patients with venous ulceration underwent descending phlebography (Herman's grading 0-4) and AVP/refilling time 90 (RT90) measurements.
- Limbs were categorized into Group I (no popliteal reflux, Grades 0-2) and Group II (popliteal reflux, Grades 3-4).
- Ascending phlebography identified deep to superficial and perforating vein incompetence.
Main Results:
- Group II (popliteal reflux) exhibited significantly higher mean AVP (71.6 ± 12.7 mmHg) compared to Group I (47.2 ± 9.3 mmHg).
- Ankle tourniquet application significantly reduced AVP in both groups, but the absolute AVP remained higher in Group II.
- Hemodynamic changes previously attributed to deep venous insufficiency were primarily observed in limbs with popliteal incompetence.
Conclusions:
- Femoral valve incompetence with competent popliteal valves contributes minimally to hemodynamic changes compared to superficial reflux.
- Co-existing deep to superficial reflux and superficial valve incompetence are key drivers of venous hypertension and ulceration.
- Significant hemodynamic abnormalities (high AVP, short RT90) indicative of deep venous insufficiency occur only with popliteal valve incompetence.
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