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Quantifying saphenous recirculation in patients with primary lower extremity venous reflux
Christopher R Lattimer1, Mustapha Azzam2, Evi Kalodiki1
1Josef Pflug Vascular Laboratory, Department of Vascular Surgery, Ealing Hospital, Middlesex, United Kingdom; Department of Surgery and Cancer, Imperial College, London, United Kingdom; Department of Vascular Surgery, Northwick Park Hospital, Middlesex, United Kingdom.
Journal of Vascular Surgery. Venous and Lymphatic Disorders
|March 20, 2016
Summary
The great saphenous vein (GSV) can cause harmful reflux in venous insufficiency. A new recirculation index (RCI) quantifies this reflux, showing it outweighs beneficial drainage and aiding clinical assessment.
Area of Science:
- Vascular Medicine
- Ultrasound Imaging
- Hemodynamics
Background:
- The great saphenous vein (GSV) plays a dual role in superficial venous insufficiency, potentially aiding drainage but also promoting harmful reflux and skin changes.
- Quantifying the balance between beneficial antegrade drainage and detrimental reflux within the GSV is crucial for understanding disease progression.
Purpose of the Study:
- To measure antegrade and retrograde GSV volume displacements during calf compression and release maneuvers.
- To develop a quantitative measure, the recirculation index (RCI), to assess the harm (reflux) over benefit (drainage) in GSV function.
Main Methods:
- Duplex ultrasound was used to scan the upper thigh GSV in 16 patients with primary superficial venous insufficiency.
- Manual and cyclical calf compression and release (MCCR and CCCR) maneuvers were performed to assess GSV volume displacements and reflux.
- The cyclical calf-cuff provided standardized compression (120 mm Hg for 3 seconds) and refilling times (16.4 seconds).
Main Results:
- Cyclical calf compression and release (CCCR) resulted in significantly longer reflux duration, higher mean velocities in reflux, and greater reflux volume displacements compared to manual compression (MCCR).
- Significant correlations were found between antegrade and reflux volume measurements, suggesting antegrade flow influences reflux.
- The recirculation index (RCI), calculated as the ratio of reflux volume to antegrade volume, was 2.14 with CCCR, indicating a predominant recirculation phenomenon. Repeatability of the RCI was excellent.
Conclusions:
- The study successfully measured GSV behavior, quantifying harmful reflux over beneficial drainage using the RCI.
- The RCI offers a standardized method to assess saphenous vein recirculation, potentially overcoming limitations of previous provocation tests.
- Further prospective studies are recommended to validate the RCI against clinical outcomes and quality of life parameters.
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