Associations of anterior accessory or thigh posterior tributary and great saphenous reflux patterns in early stages of chronic venous valvular insufficiency

Abstract

Varicose veins are a common disorder. Extensive ultrasound (US) mapping of lower extremity chronic venous valvular insufficiency includes the great saphenous vein (GSV), anterior accessory saphenous vein (AASV) and thigh posterior tributary to GSV such as the posterior accessory saphenous vein (PTSV, PASV). The aim of this study was to determine associations between GSV-AASV-PTSV (including PASV) reflux in a specific sample population of Southern Brazilian women, mostly euro descendents, with telangiectasias, reticular veins, varices and/or intermittent edema. US performed in 1016 extremities of 513 women, 43±18 (18-81) years old were included. Women with previous venous thrombosis, surgery, suspicion of pelvic congestion syndrome, and men were excluded. Small saphenous vein and related thigh veins were excluded from analysis. GSV-AASV-PTSV reflux patterns were analyzed; prevalence was compared using χ2 statistics. Reflux prevalence in AASV and/or thigh PTSV was 5.8% (59/1016): 1.3% at PTSV (n=13) and 4.5% at AASV (n=46), significantly lower than GSV reflux: 72% (n=727) (P<0.001). AASV and/or PTSV reflux was associated with GSV reflux (81%, n=48/59); common pattern was diffuse reflux, starting at AASV/PTSV saphenous junctions (56%, n=33/59; otherwise, short, non-diffuse reflux was noted in part of the AASV/PTSV evaluated. Isolated AASV or PTSV reflux was rare (1%, n=11/1016): 9 at the AASV, and 2 at the PTSV. US mapping of AASV/PTSV in early stages of disease, in women without pelvic congestion syndrome, increased reflux detection by 1%, and improved definition of reflux patterns in about 6% of the extremities.

Keywords

• venous valvular insufficiency, duplexdoppler ultrasound, great saphenous vein, anterior accessory saphenous vein, posterior accessory saphenous vein, posterior tributary vein.