Patterns of reflux and severity of varicose veins in the general population - Edinburgh Vein Study

Objectives: several studies have used duplex ultrasound to assess valvular incompetence in symptomatic patients. This cross-sectional survey was performed to determine, for the first time in a general population sample, the relationship between trunk varices and the presence of reflux in lower limb venous segments. Materials and Methods: 1238 subjects (554 male, 684 female), aged 18-64 years, were randomly selected. The presence and severity of any trunk varices was assessed and classified into Grades 1-3; hyphenweb and reticular varices were noted. The presence or absence of reflux greater than or equal to 0.5 s in five deep and three superficial venous segments in each leg was assessed using duplex ultrasound. Results: the prevalence of reflux increased in both superficial and deer segments with more severe grades of trunk varices (p less than or equal to0.01), except the upper SFV in women. Fifteen per cent of females showed reflux confined to the superficial system, compared with 9% of males (p less than or equal to0.001); 22% of males showed deep reflux, compared with 11% of females (p less than or equal to 0.001). 71% of men and 48% of women with Grade 2-3 trunk varices had mixed deep and superficial reflux. Above-knee popliteal segments had a higher prevalence of reflux than lower SFV segments in all groups. There was no consistent relationship between the presence of hyphenweb or reticular varices and deep or superficial reflux. Conclusion: segmental venous reflux can be detected in the deep and superficial leg veins of subjects without trunk varices, but superficial and mixed reflux are increasingly found in subjects with more severe varices.