The relationship between lower limb symptoms and superficial and deep venous reflux on duplex ultrasonography: The Edinburgh Vein Study

Background: Previous work from this group has demonstrated the relationships between lower limb symptoms and the presence and severity of trunk varicose veins as seen on clinical examination to be generally weak, symptom specific, and gender dependent. Objective: This study was undertaken to investigate the relationships in the general population between lower limb symptoms and the presence of superficial or deep venous reflux. Methods: A cross-sectional study was made of an age-stratified random sample of 1566 subjects (699 men and 867 women) aged 18 to 64 selected from 12 general practices in Edinburgh, Scotland. Subjects completed a self-administered questionnaire regarding symptoms (heaviness/tension, a feeling of swelling, aching, restless legs, cramps, itching, tingling) and underwent duplex ultrasound examination of the superficial and deep venous systems of both legs. Reflux of 0.5 seconds or greater was considered pathologic. Deep venous reflux was defined as reflux in at least the popliteal vein. Results: There was a significant positive relationship between isolated superficial reflux and the presence of heaviness/tension (P < .025, both legs) and itching (P = .002, left leg) in women. Isolated superficial reflux in men tvas not significantly positively associated with any symptom. Isolated deep venous reflux was not significantly related to any symptom in either leg in either sex. Combined reflux was related to a feeling of swelling (P = .018, right leg; P = .0022, left leg), cramps (P =.0049, left leg) and itching (P = .0043, left leg) in men, and aching (P = .03, right leg) and cramps (P = .026, left leg) in women. Conclusion: In the general population, only certain lower limb symptoms were related to the presence of reflux on duplex ultrasound scanning. The strongest relationships were observed in the left legs of men with combined superficial and deep reflux.