title: The importance of deep venous reflux velocity as a determinant of outcome in patients with combined superficial and deep venous reflux treated with endovenous saphenous ablation.
abstract: BACKGROUND
  Twenty to thirty percent of patients with symptomatic chronic venous insufficiency (CVI) are found to have combined superficial and deep venous reflux on duplex testing. It is currently unclear whether endovenous ablation (EVA) of the saphenous vein will result in correction of CVI without addressing the deep venous reflux. In this study, we examined deep venous reflux velocities to determine whether these would predict outcome after endovenous ablation.
  
  
  METHODS
  Patients with symptomatic CVI and both saphenous and deep venous reflux were identified using duplex ultrasonography. Reflux times and maximal reflux velocity (MRV) in each examined vein segment were determined. In each limb, the venous filling index (VFI) and the venous clinical severity score (VCSS) were obtained both before and after laser ablation of the great and/or small saphenous veins. Preoperative venous reflux velocities were correlated with improvement in VFI and VCSS after ablation.
  
  
  RESULTS
  75 limbs with both deep and superficial venous reflux were identified. Seventy-five percent of limbs were CEAP clinical class 3 or 4 and the other 25% were class 5 or 6. Forty limbs demonstrated deep venous reflux in the femoral and/or popliteal vein. After EVA, significant improvements in VFI and VCSS were seen, but this depended on MRV in the deep vein. When MRV in the popliteal or femoral vein was <10 cm/sec, limbs had significantly better outcomes than limbs with MRV >10 cm/sec as measured by both VFI (P = .01) and VCSS (P = .03). In 35 limbs, deep venous reflux was identified only in the CFV. In this group, the average pre-procedure VFI (6.54 +/- 3.9 cc/sec) decreased significantly to 2.2 +/- 1.9 cc/sec (P < .001) and the VCSS improved markedly from 7.0 +/- 2.8 to 1.3 +/- 1.4 (P < .001).
  
  
  CONCLUSIONS
  EVA of the saphenous veins can be performed in patients with concomitant deep venous insufficiency with hemodynamic and clinical improvement in most cases. Patients with popliteal or femoral reflux velocities lower than 10 cm/sec usually experience marked improvement in both the VFI and the VCSS. Patients with femoral or popliteal reflux velocities greater than 10 cm/sec have a high incidence of persistent symptoms after EVA.
authors.affiliation: Division of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Marston
authors.forename: V Wells
authors.initials: VW
authors.lastname: Brabham
authors.forename: Robert
authors.initials: R
authors.lastname: Mendes
authors.forename: Daniel
authors.initials: D
authors.lastname: Berndt
authors.forename: Meredith
authors.initials: M
authors.lastname: Weiner
authors.forename: Blair
authors.initials: B
authors.lastname: Keagy
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000379:methods; D001783:Blood Flow Velocity; D017115:Catheter Ablation / Q000379:methods*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010991:Plethysmography / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012501:Saphenous Vein / Q000601:surgery*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D014690:Venous Pressure