Patterns of venous insufficiency in patients with varicose veins
L. M. Hanrahan, G. J. Kechejian, P. R. Cordts, A. A. Rodriguez, C. A. Araki, W. W. LaMorte and J. O. Menzoian
Department of Surgery, Boston University Medical Center, MA 02118.
The nature and distribution of venous disease surrounding the development
of varicose veins and its treatment is controversial. Using duplex
ultrasonography, we evaluated 54 lower extremities in 32 patients with
varicose veins who were symptomatic and had obvious varicose veins by
clinical examination. Twenty-eight percent had greater saphenous trunk
incompetence, 2% had lesser saphenous trunk incompetence, and 96% had
branch disease. Deep valvular incompetence was seen in 41%, saphenofemoral
junction incompetence in 46%, and incompetence of one or more perforators
in 46% of the extremities. Thirty-three percent demonstrated no evidence of
associated saphenofemoral junction, deep vein, or perforating vein
incompetence, while 20% had concurrent saphenofemoral junction, deep vein,
and perforating vein incompetence. These data support the heterogeneity of
venous disease seen in patients with varicose veins and suggest that
surgical therapy be directed to a patient's specific pattern of
incompetence rather than routine saphenofemoral junction ligation or
stripping of the greater saphenous trunk.
