Quantification of venous reflux by means of duplex scanning

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Presentation transcript:

Quantification of venous reflux by means of duplex scanning Spiros N. Vasdekis, MD, G.Heather Clarke, PhD, Andrew N. Nicolaides, MS Journal of Vascular Surgery Volume 10, Issue 6, Pages 670-677 (December 1989) DOI: 10.1016/0741-5214(89)90011-6 Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Examination of the popliteal and short saphenous veins for reflux by use of duplex scanning. Note the slight flexion of the knee and the frame the patient is holding onto. Reflux is the result of gravity and can be measured adequately only when the patient is in the standing position. Journal of Vascular Surgery 1989 10, 670-677DOI: (10.1016/0741-5214(89)90011-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Duplex scanning over the popliteal fossa. The popliteal artery, the popliteal vein, and the short saphenous vein joining the popliteal vein are shown on a longitudinal view. The gated Doppler sample volume has been placed in the popliteal vein. Journal of Vascular Surgery 1989 10, 670-677DOI: (10.1016/0741-5214(89)90011-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Doppler sample volume of duplex scan positioned in the popliteal vein 4 cm distal to the saphenopopliteal junction. There is cephalad flow on calf compression and reflux on release of compression indicating incompetence. Reflux quantification measurements are calculated by the software and are shown on the top and on the right of the screen. In this particular case the average velocity at peak reflux (arrow) was 30 cm/sec; the cross-sectional area of the vein (area) was 0.46 cm2; thus flow at peak reflux was 30 × 0.46 = 13.8 ml/sec. Journal of Vascular Surgery 1989 10, 670-677DOI: (10.1016/0741-5214(89)90011-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Duplex scanning at the saphenofemoral junction (SF). A, the pulsed Doppler sample volume is in the femoral vein 4 cm distal to the SF junction. There is cephalad flow (away from the probe) on calf compression, but no reflux on release of the compression indicating competent valves; B, Doppler sample volume positioned in the long saphenous vein 4 cm distal to the SF junction. Reflux on release of the compression indicates incompetence. Journal of Vascular Surgery 1989 10, 670-677DOI: (10.1016/0741-5214(89)90011-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Duplex scan of the posterior tibial vein (PT V), a tortuous perforating vein, communicates with the right long saphenous vein (R LS V). The Doppler sample volume is placed in the perforating vein. Reflux is demonstrated on release of the compression. Journal of Vascular Surgery 1989 10, 670-677DOI: (10.1016/0741-5214(89)90011-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Flow at peak reflux measured in individual veins (LS, long saphenous, SS, short saphenous vein; POP, popliteal vein; FEM, femoral vein; L + S, reflux in the long and short saphenous veins; LS, SS, P-F, reflux in the long, short, popliteal, and femoral veins. Note the higher incidence of skin changes (black dots) with higher amounts of reflux irrespective of whether the incompetence is in the deep or superficial veins. Journal of Vascular Surgery 1989 10, 670-677DOI: (10.1016/0741-5214(89)90011-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Flow at peak reflux (same data as in Fig. 6) in limbs without skin changes (group A) and in limbs with liposclerosis and/or ulceration (group B). Journal of Vascular Surgery 1989 10, 670-677DOI: (10.1016/0741-5214(89)90011-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Duration of reflux (refilling time) in limbs without skin changes (group A) and in limbs with liposclerosis and/or ulceration (group B). Journal of Vascular Surgery 1989 10, 670-677DOI: (10.1016/0741-5214(89)90011-6) Copyright © 1989 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions