Haemodynamic and clinical impact of superficial, deep and perforator vein incompetence

Objective. The purpose of this study zoos to assess the effect of venous incompetence of the deep, superficial and perforator veins combined (i.e. multi-system incompetence) oil the venous haemodynamics and clinical condition of limbs with chronic venous disease (CVD). Methods. Die hundred and thirty two limbs (16-C-1; 30-C-2; 20-C-3, 25-C-4; 21-C-5; 20-C-6) of 121 patients were studied. We excluded those With previous venous stirgery/sclerotherapy, peripheral arterial disease, recent deep vein thrombosis (<= 6 months), or inability to comply With the tests. The CEAP clinical class was assessed. Duplex ultrasonography (ultrasound) enabled classification according to: the presence of superficials, (+/- perforator([P])) or deep([D]), (+/- S, +/- P) refliix (> .5 s); the number of incompetent venous systems (single-system([S/P/D]), dual-system([S+P/S+D]), or triple-system([S+P+D])), and the number of incompetent perforators([0/1/2/>= 3]). The amount of reflux (Venous Filling Index([VFI])); calf pump Ejection Fraction([EF]), and Residual Volume Fraction([RVF]) were studied with air-plethysmography. Results. VFI in limbs with triple-system incompetence (VFI median 6.68 [IQR: 4.7-9.7] ml/s) was higher than in limbs with dial-system incompetence (4.5 [2.1-7.4] ml/s), and VFI in the latter was higher than in limbs with single-system incompetence (1.3 [0.69-2.3] ml/s)(p < 0.01 Kruskal-Wallis). Although EF changes were small, RVF in limbs with triple-incompetence (39 [30-51] %) was higher than in single-system incompetence (26 [16-33] %) (p < 0.01) and RVF (p < 0.02) than limbs with deep (+/- S +/- P) Limbs with superficial (+/- P) incompetence had a lower VFI (p < 0.01) and RVF (p < 0.02) than limbs with deep (+/- S +/- P) bicompetence, and limbs with >= 2 incompetent perforator veins had a higher VFI (p < 0.04) than those without perforators. All limbs with single-system incompetence were C1-3, whereas 78% of those with triple-incompetence were C4-6 (p < 0.01). The number of incompetent systems increased with clinical class (p < 0.01). Conclusions. The frequency of incompetence of more than one venous system increased With the clinical severity of venous disease and was accompanied by a 5-fold increase in the amount of reflux and a 50% rise in the RVF The number of incompetent perforators per limb increased with the amount of reflux. The number of incompetent venous systems (supeificial, deep, petforator) and perforator veins can be assessed by duplex ultrasound giving all objective indication of the functional severity of venous disease. In this Way duplex ultrasound could be used to grade venous function in clinical practice as all alternative to APG measures which are less widely available.