Haemodynamic and Clinical Impact of Superficial, Deep and Perforator Vein Incompetence

The purpose of this study was to assess the effect of venous incompetence of the deep, superficial and perforator veins combined (i.e. multi-system incompetence) on the venous haemodynamics and clinical condition of limbs with chronic venous disease (CVD). One hundred and thirty two limbs (16-C 1; 30-C 2; 20-C 3; 25-C 4; 21-C 5; 20-C 6) of 121 patients were studied. We excluded those with previous venous surgery/sclerotherapy, peripheral arterial disease, recent deep vein thrombosis (≤6 months), or inability to comply with the tests. The CEAP clinical class was assessed. Duplex ultrasonography (ultrasound) enabled classification according to: the presence of superficial [S] (± perforator [P]) or deep [D] (±S, ±P) reflux (>.5 s); the number of incompetent venous systems (single-system [S/P/D], dual-system [S+P/S+D/P+D], or triple-system [S+P+D]), and the number of incompetent perforators [0/1/2/≥3]. The amount of reflux (Venous Filling Index [VFI]); calf pump Ejection Fraction [EF], and Residual Volume Fraction [RVF] were studied with air-plethysmography. VFI in limbs with triple-system incompetence (VFI median 6.68 [IQR: 4.7–9.7] ml/s) was higher than in limbs with dual-system incompetence (4.5 [2.1–7.4] ml/s), and VFI in the latter was higher than in limbs with single-system incompetence (1.3 [0.69–2.3] ml/s)( p