The nature of lower extremity venous insufficiency in patients with primary varicose veins

The purpose of this study was to investigate the distribution of vein incompetence and the nature of venous haemodynamics accompanying the development of lower extremity primary varicose veins (LEPVV). The entire venous circulation of 77 lower extremities in 55 patients (pts) with LEPVV was evaluated, by using Duplex colour Doppler ultrasonography. The greater and lesser saphenous veins (GSV, LSV) and their branches were thoroughly scanned. The valvular integrity of the deep venous system was determined in the areas of common and superficial femoral vein, saphenofemoral junction, popliteal vein, saphenopopliteal junction, and perforating veins. Demonstration of bidirectional flow signified venous incompetence. Quantitation of venous reflux was estimated after manual calf compression with pts in a standing position. All the symptomatic legs had branch venous disease, 60% had GSV incompetence, 3% had LSV incompetence, 10% showed concurrent GSV and LSV incompetence, while 27% demonstrated no evidence of GSV, and LSV disease. Thirty per cent and 50% of the symptomatic legs demonstrated deep and perforating vein incompetence, respectively. Furthermore, 30% of the asymptomatic lower extremities had insufficiency of saphenofemoral (nine pts) and saphenopopliteal (one pt) junction. The median peak venous reflux in the incompetent GSV and popliteal vein was 0.74 ml/s (range 0.2 to 2.5 ml/s) and 3.5 ml/s (range 2.5 to 8 ml/s), respectively. In conclusion, the observed heterogeneity in anatomic and functional distribution of lower extremity venous insufficiency in pts with LEPVV support the hypothesis that this condition is probably a part of another entity that might be called “lower extremity primary venous insufficiency” whose treatment should be highly individualised. To this end, colour Doppler imaging can help.