Venous reflux in symptom-free vascular surgeons

Work posture and occupation are among the most controversial predisposing factors associated with venous disease. We examined the distribution and extent of venous reflux in the lower extremities of symptom-free vascular surgeons, who were typically classified as leading a life of prolonged standing, in comparison to a group of symptom-free volunteers.

In this prospective study (January 1991 to April 1994), the venous system in the lower limb veins of 28 vascular surgeons (56 limbs) and 25 normal volunteers (50 limbs) was examined by color-flow duplex imaging. The two groups were matched for age (29 to 45 years) and sex (all men). Subjects with clinical signs and symptoms of venous disease, history of deep or superficial vein thrombosis, or previous venous operation or injection sclerotherapy were not included in the study (12 vascular surgeons).

Venous reflux was detected in 29 limbs of vascular surgeons (52%) and in 16 limbs of the control group (32%) (chi-squared test = 4.232, p = 0.039). In the latter, superficial venous incompetence was detected in 9 of 50 limbs (18%), deep venous or perforator incompetence in 3 of 50 limbs (6%), and venous incompetence involving both the superficial and deep systems in 4 of 50 limbs (8%). In the group of vascular surgeons, reflux in the superficial veins was seen in 22 of 56 limbs (39%), in the deep and or perforating veins in 4 of 56 limbs (7%), and in both the superficial and deep veins in 3 of 56 limbs (5%). Superficial venous reflux was more frequently encountered in the limbs of 45% of vascular surgeons (25 of 56) than in the limbs of the control subjects 26% (13 of 50) (chi-squared test = 3.99, p = 0.047). Distal long saphenous vein reflux alone accounted for 39% (5 of 13) of any superficial venous incompetence in the limbs of the control subjects, and was higher, at 48% (12/25), in the vascular surgeons. Reflux in the gastrocnemial veins was equally distributed between the limbs of the control subjects (10%) and the vascular surgeons (11%).

Venous reflux was more frequently seen among symptom-free vascular surgeons than normal individuals of a nonmedical vocation. The superficial system was by far the most common site of venous incompetence in both groups. Below-knee-long saphenous vein reflux in any combination was present in more than 75% of the limbs with superficial venous incompetence.