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Nicos Labropoulos - One of the best experts on this subject based on the ideXlab platform.
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Color Duplex for Diagnosis of Venous Reflux
Noninvasive Vascular Diagnosis, 2017Co-Authors: Albeir Y. Mousa, Nicos LabropoulosAbstract:Venous Reflux disease is the significant contributing pathology for limb swelling in the outpatient population. Reflux can occur at different degrees and levels, with presentation specific to each level and type of Reflux. Understanding the entire pathophysiology and possible consequences is imperative in establishing an adequate treatment strategy. Currently, Venous duplex ultrasound is the main diagnostic test used to characterize anatomy and physiology of lower extremity Venous Reflux.
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Saphenous vein wall thickness in age and Venous Reflux-associated remodeling in adults.
Journal of vascular surgery. Venous and lymphatic disorders, 2017Co-Authors: Nicos Labropoulos, Kelli Summers, Ignacio Escotto Sanchez, Joseph D. RaffettoAbstract:Abstract Objective This prospective study was designed to determine the great saphenous vein (GSV) wall thickness in age-related and Venous Reflux-associated remodeling. Methods GSV wall thickness was measured in the thigh and calf using a duplex ultrasound 17-MHz transducer. Interobserver and intraobserver variability studies were performed. Two healthy control groups, each with 10 individuals (20 limbs), were selected on the basis of age. Group 1 had a mean age of 21 years, and group 2 had a mean age of 64 years. Forty patients with chronic Venous disease signs and symptoms and GSV Reflux of >2 seconds were enrolled. The vein wall thickness was assessed in vein segments with Reflux and adjacent segments without Reflux in the patient group. Results The measurements were valid as the variability for each rater was far below the difference in vein wall thickness measurements in all comparisons. In controls and patients, respectively, rater one had a range of 0.11 mm and 0.16 mm, and rater two had a range of 0.09 mm and 0.15 mm. The vein wall thickness significantly increased ( P Conclusions This human in vivo study demonstrated that GSV wall thickness significantly increases with age and in patients with Venous Reflux. The increased vein wall thickness in nonRefluxing segments of chronic Venous disease patients suggests that the Venous wall can be affected before Reflux is present in a particular segment.
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Multicenter assessment of Venous Reflux by duplex ultrasound
Journal of vascular surgery, 2011Co-Authors: Fedor Lurie, Nicos Labropoulos, Robert L. Kistner, Bo Eklof, William A Marston, Anthony J. Comerota, Mark H. Meissner, Joann M. Lohr, Gregory L. Moneta, Peter NeglénAbstract:Objective This prospective multicenter investigation was conducted to define the repeatability of duplex-based identification of Venous Reflux and the relative effect of key parameters on the reproducibility of the test. Methods Repeatability was studied by having the same technologist perform duplicate tests, at the same time of the day, using the same Reflux-provoking maneuver and with the patient in the same position. Reproducibility was examined by having two different technologists perform the test at the same time of the day, using the same Reflux-provoking maneuver and with the patient in the same position. Facilitated reproducibility was studied by having two different technologists examine the same patients immediately after an educational intervention. Limits of agreement between two duplex scans were studied by changing three elements of the test: time of the day (morning vs afternoon), patient's position (standing vs supine), and Reflux initiation (manual vs automatic compression–decompression). Results The study enrolled 17 healthy volunteers and 57 patients with primary chronic Venous disease. Repeatability of Reflux time measurements in deep veins did not significantly differ with the time of day, the patient's position, or the Reflux-provoking maneuver. Reflux measurements in the superficial veins were more repeatable ( P P Conclusions This study provides evidence to develop a new standard for duplex ultrasound detection of Venous Reflux. Reports should include information on the time of the test, the patient's position, and the provoking maneuver used. Adopting a uniform cut point of 0.5 second for pathologic Reflux can significantly improve the reliability of Reflux detection. Implementation of a standard protocol should elevate the minimal standard for agreement between repeated tests from the current 70% to at least 80% and with more rigid standardization, to 90%.
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Prevalence of deep Venous Reflux in patients with primary superficial vein incompetence
Journal of vascular surgery, 2000Co-Authors: Nicos Labropoulos, Apostolos K. Tassiopoulos, Steven S. Kang, M. Ashraf Mansour, Fred N. Littooy, William H. BakerAbstract:Abstract Purpose: This prospective study was designed to determine the prevalence of deep Reflux and the conditions under which it may occur in patients with primary superficial Venous Reflux and absence of deep Venous thrombosis (DVT). Methods: We studied 152 limbs in 120 consecutive patients in the standing position who had superficial Venous Reflux with color flow duplex scanning. Limbs with documented evidence of DVT or post-thrombotic vein wall changes during the examination were studied but not included in the analysis. Limbs were divided into those that had at least Reflux in the saphenofemoral, the saphenopopliteal, or the gastropopliteal junction and into those with nonjunctional Reflux in the superficial and gastrocnemial veins. Peak velocity and duration of Reflux were measured. To examine the recirculation theory, we tested the deep veins by occluding and Refluxing saphenous veins 10 cm below the sampling site. Results: Thirteen limbs in 11 patients (9%) were excluded because of previous DVT. Of the remaining 139 limbs, 106 (76%) had junctional Reflux. Saphenofemoral junction was involved in 89 limbs (84%), saphenopopliteal junction in 18 (17%), and gastropopliteal junction in 7 (4%). In 33 limbs (24%), Reflux was detected in the main trunk or tributaries of the saphenous veins alone with no junctional incompetence. Femoral or popliteal Reflux was present in 31 limbs (22%). This Reflux was segmental in 27 limbs, and it was limited in the junction in 24 limbs. The mean duration of deep Venous Reflux was 0.9 seconds, it ranged from 0.6 to 3.7 seconds, and it was significantly shorter than that in the superficial veins (2.6 seconds; P P =.038). The mean duration of deep Venous Reflux in these groups was comparable (0.85 seconds vs 0.91 seconds; P =.44). Occlusion of the incompetent superficial veins reduced somewhat the duration of the deep Venous Reflux but did not abolish it (0.88 seconds vs 0.82 seconds; P =.072). The presence of DVI was associated with junctional Reflux of high peak velocity and long duration. Conclusions: The prevalence of DVI in patients with primary superficial Venous Reflux and without history of DVT is 22%. However, this Reflux is segmental, mainly in the common femoral vein, and is of short duration. It is associated with the presence of junctional incompetence that has a high peak velocity and long duration. These findings may explain why surgical correction of superficial Reflux abolishes DVI. (J Vasc Surg 2000;32:663-8.)
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Insights in the Development of Primary Venous Reflux
Vascular Surgery, 1999Co-Authors: Nicos Labropoulos, Athanasios D. Giannoukas, George T. Stavridis, David Bailey, Brian Glenville, Andrew N. NicolaidesAbstract:Purpose: The relation between vein wall fibrosis and presence of primary Venous Reflux was investigated. Methods: Twenty-eight limbs of 27 patients undergoing coronary bypass surgery without history of superficial or deep Venous thrombosis and without clinical evidence of varicose veins were subjected preoperative ultrasonic investigation of the long saphenous vein (LSV) and its tributaries in order to detect presence of Reflux. Histologic examination of vein specimens, harvested perioperatively from premarked sites of the LSV (ankle, knee, and midthigh) and its tributaries, was carried out. The specimens were classified according to the fibrotic content of the wall on histology as normal, mildly, moderately, and severely affected. (continued on next page) Results: Sixteen limbs (57%) had Reflux. Saphenofemoral junction (SFJ) incompetence alone was not seen, and this always was present in association with an incompetent LSV (3/16, 19%). Reflux was equally distributed (37.5%) in the above- (6/16) and below-knee (6/16) segments, whereas in three limbs it was present throughout the LSV. Fibrosis was seen in the majority of the specimens taken from the LSV (62/65, 95%) and its tributaries (21/32, 66%), irrespective of the presence or absence of Reflux. Different grades of fibrosis were found on histology in different sites of the same vein. Conclusions: Venous wall fibrosis very often exists in the absence of Reflux and Venous insufficiency occurs at any segment of the LSV with minor involvement of the SFJ. Thus, primary Venous Reflux seems to be a locally developing process.
Kaneshige Satoh - One of the best experts on this subject based on the ideXlab platform.
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external valvuloplasty for subcutaneous small veins to prevent Venous Reflux in lymphaticovenular anastomosis for lower extremity lymphedema
Plastic and Reconstructive Surgery, 2013Co-Authors: Shinsuke Akita, Hideki Tokumoto, Yoshitaka Kubota, Motone Kuriyama, Nobuyuki Mitsukawa, Masakazu Hasegawa, Tomoe Koizumi, Tatsuya Ishigaki, Kaneshige SatohAbstract:BACKGROUND: Subcutaneous ecchymosis caused by Venous Reflux is a preventable complication following lymphaticovenular anastomosis. The authors developed a series of operative procedures to prevent Venous Reflux. This is probably the first report on valvuloplasty for small subcutaneous veins (diameter, <1 mm). METHODS: A total of 165 anastomoses in 39 limbs were operated on using this novel procedure (study group). Extended vein dissection was performed to ensure inclusion of some Venous valves. Venous regurgitation was assessed using a retrograde milking test. When regurgitation was observed at all peripheral branches, external valvuloplasty was performed at the small subcutaneous vein to prevent backflow. The rate of Venous Reflux was compared with 151 anastomoses in 34 limbs operated on using conventional procedures (control group). Moreover, the amount of volume reduction was compared between the patients with and without Venous Reflux. RESULTS: In the study group, the rate of regurgitation was reduced (3.0 percent) by extended vein dissection compared with that in the control group (9.9 percent), whereas the regurgitation ceased completely following external valvuloplasty (0 percent). In addition, postoperative ecchymosis was prevented completely in the study group (8.8 percent in the control group). Perioperative improvement in the lower extremity lymphedema index was significantly different between the patients with and without Venous Reflux (with Venous Reflux, 0.0706 ± 0.0742; without Venous Reflux, 0.0904 ± 0.0614). CONCLUSIONS: The authors' results suggest that these operative procedures could be highly effective in preventing Venous Reflux. Moreover, Venous Reflux, if not corrected, leads to worsening of the results. Excellent results were consistently achieved by preventing Venous Reflux. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
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External valvuloplasty for subcutaneous small veins to prevent Venous Reflux in lymphaticovenular anastomosis for lower extremity lymphedema.
Plastic and reconstructive surgery, 2013Co-Authors: Shinsuke Akita, Hideki Tokumoto, Yoshitaka Kubota, Motone Kuriyama, Nobuyuki Mitsukawa, Masakazu Hasegawa, Tomoe Koizumi, Tatsuya Ishigaki, Kaneshige SatohAbstract:BACKGROUND: Subcutaneous ecchymosis caused by Venous Reflux is a preventable complication following lymphaticovenular anastomosis. The authors developed a series of operative procedures to prevent Venous Reflux. This is probably the first report on valvuloplasty for small subcutaneous veins (diameter,
Andrew W. Bradbury - One of the best experts on this subject based on the ideXlab platform.
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The effect of long saphenous vein stripping on deep Venous Reflux.
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2004Co-Authors: R.k Mackenzie, Paul L. Allan, C. V. Ruckley, Andrew W. BradburyAbstract:Abstract Background. The addition of long saphenous vein (LSV) stripping to sapheno-femoral junction (SFJ) disconnection and multiple stab avulsions (MSAs) in the course of varicose vein (VV) surgery is associated with a significant reduction in recurrence, and a significant improvement in quality of life. It is hypothesised that these benefits relate, at least in part, to a favourable effect of stripping on deep Venous Reflux. Objective. To examine the effect of long saphenous vein (LSV) stripping on deep Venous Reflux (DVR). Methods. This was prospective study of 62 consecutive patients (77 limbs) CEAP class 2–6, undergoing SFJ disconnection and MSAs, with and without successful stripping of the LSV to the knee. A duplex ultrasound examination was performed pre-operatively and at a median (IQR) of 24 (23–25) months post-operatively. Completely stripped limbs were defined as those in whom complete stripping of the LSV to the knee was confirmed on post-operative duplex. Reflux ≥0.5 s. was considered pathological. Results. Pre-operatively, 32 (42%) limbs had deep Venous Reflux (DVR). Post-operative duplex at 24 months revealed that the LSV had been completely stripped in 29 (38%) limbs. In patients with pre-operative DVR, complete stripping was associated with a significant reduction in the prevalence of superficial femoral vein (SFV) ( p p =0.016), McNemar test) on post-operative duplex. By contrast, in patients without pre-operative DVR, incomplete stripping was associated the development of SFV ( p =0.031) and PV ( p =0.008) Reflux. Conclusions. Complete LSV stripping abolishes DVR in a significant proportion of limbs, whereas failure to strip is frequently associated with the development of new DVR. These data support for routine stripping and suggest that the benefits of stripping may relate, at least in part, to a favourable impact on deep Venous function.
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Most incompetent calf perforating veins are found in association with superficial Venous Reflux.
Journal of vascular surgery, 2001Co-Authors: W.p. Stuart, Amanda J Lee, Paul L. Allan, C. Vaughan Ruckley, Andrew W. BradburyAbstract:Abstract Purpose: The indications for surgical perforator interruption remain undefined. Previous work has demonstrated an association between clinical status and the number of incompetent perforating veins (IPVs). Other studies have demonstrated that correction of IPV physiology results from abolition of saphenous system Reflux. The purpose of this study was to identify which, if any, patterns of Venous Reflux and obstruction are particularly associated with IPV. Patients and Methods: Two hundred thirty patients and subjects (103 men, 127 women, 308 limbs) with varying grades of Venous disease were examined both clinically and with duplex ultrasound scan. The odds ratios (ORs) for the presence of IPVs were calculated for different anatomical distributions of main-stem Venous Reflux and obstruction. The base group are those with no main-stem Venous disease. Results: There were no significant associations between the proportions of limbs demonstrating IPVs and patient age or sex. The ORs for the presence of IPVs in association with other Venous disease are as follows (age/sex adjusted): long saphenous vein Reflux, OR=1.86, range=1.32-2.63; short saphenous vein Reflux, OR=1.36, range=1.02-1.82; deep system Venous Reflux, OR=1.61, range=1.2-2.15; superficial system Reflux, OR=3.17, range=1.87-5.4; and deep system obstruction, OR=1.09, range=0.51-2.33. The ORs for combinations of Venous disorders were calculated. Combinations of disease produced higher odds for the presence of IPVs than those above, the highest being long saphenous vein, short saphenous vein, and deep Reflux combined, OR=6.85 (95% CI, 2.97-15.83; P =.0001). Conclusions: Although the presence of IPVs is associated with Venous ulceration, the highest ORs for the presence of IPVs were found in patients with superficial disease alone or in combination with deep Reflux. Many of these may be corrected by saphenous surgery alone. (J Vasc Surg 2001;34:774-8.)
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Comparison of Venous Reflux in the affected and non-affected leg in patients with unilateral Venous ulceration
The British journal of surgery, 1996Co-Authors: Andrew W. Bradbury, Paul L. Allan, Julie Brittenden, C. V. RuckleyAbstract:In 54 patients with unilateral leg ulceration of purely Venous aetiology the only difference in Venous Reflux between affected and non-affected legs was with respect to the popliteal and crural veins. Deep and superficial Venous Reflux is common in legs without the skin changes typical of chronic Venous insufficiency. The significance of Venous Reflux in an ulcerated leg cannot therefore be determined without reference to the contralateral, clinically normal, limb. Surgery should be directed at correcting Reflux present in the ulcerated limb but not in the unaffected limb. In a minority of patients this entails superficial Venous surgery alone, but in the majority such an approach would, ideally, entail correction of deep Venous incompetence.
Shinsuke Akita - One of the best experts on this subject based on the ideXlab platform.
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Prevention of Venous Reflux with full utilization of venoplasty in lymphaticovenular anastomosis
Journal of plastic reconstructive & aesthetic surgery : JPRAS, 2019Co-Authors: Shinsuke Akita, Yoshihisa Yamaji, Hideki Tokumoto, Haruka Maei, Takafumi Tezuka, Hideyuki Ogata, Kentaro Kosaka, Yoshitaka Kubota, Motone Kuriyama, Nobuyuki MitsukawaAbstract:Summary Background Intraoperative retrograde blood flow from the vein to the lymphatic vessels in lymphaticovenular anastomosis (LVA) for lower extremity lymphedema (LEL) leads to poor results. This study aimed to establish a treatment strategy to control Venous Reflux in LVA. Methods A unified strategy to prevent Venous Reflux was used in 95 limbs (study group). Dilated perforating veins were ligated, and LVA at the small branch of the ligated vein was considered. External valvuloplasty in the small vein was performed to eliminate Venous Reflux pre- and post-LVA. A Y-shaped venoplasty for the relatively large vein was considered in cases without adequate-sized vein stump with a functional valve. The results were compared with the 34 limbs undergoing conventional multiple LVAs (control group). Results Intraoperative Venous Reflux and postoperative ecchymosis significantly decreased in the study group (0/462 anastomosis vs. 15/148 anastomosis, p Conclusion Using the new strategy developed in this study, Venous Reflux could be completely prevented, and stable clinical results were obtained in patients with LEL. Prevention of Venous Reflux with full utilization of venoplasty might improve the LVA result.
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external valvuloplasty for subcutaneous small veins to prevent Venous Reflux in lymphaticovenular anastomosis for lower extremity lymphedema
Plastic and Reconstructive Surgery, 2013Co-Authors: Shinsuke Akita, Hideki Tokumoto, Yoshitaka Kubota, Motone Kuriyama, Nobuyuki Mitsukawa, Masakazu Hasegawa, Tomoe Koizumi, Tatsuya Ishigaki, Kaneshige SatohAbstract:BACKGROUND: Subcutaneous ecchymosis caused by Venous Reflux is a preventable complication following lymphaticovenular anastomosis. The authors developed a series of operative procedures to prevent Venous Reflux. This is probably the first report on valvuloplasty for small subcutaneous veins (diameter, <1 mm). METHODS: A total of 165 anastomoses in 39 limbs were operated on using this novel procedure (study group). Extended vein dissection was performed to ensure inclusion of some Venous valves. Venous regurgitation was assessed using a retrograde milking test. When regurgitation was observed at all peripheral branches, external valvuloplasty was performed at the small subcutaneous vein to prevent backflow. The rate of Venous Reflux was compared with 151 anastomoses in 34 limbs operated on using conventional procedures (control group). Moreover, the amount of volume reduction was compared between the patients with and without Venous Reflux. RESULTS: In the study group, the rate of regurgitation was reduced (3.0 percent) by extended vein dissection compared with that in the control group (9.9 percent), whereas the regurgitation ceased completely following external valvuloplasty (0 percent). In addition, postoperative ecchymosis was prevented completely in the study group (8.8 percent in the control group). Perioperative improvement in the lower extremity lymphedema index was significantly different between the patients with and without Venous Reflux (with Venous Reflux, 0.0706 ± 0.0742; without Venous Reflux, 0.0904 ± 0.0614). CONCLUSIONS: The authors' results suggest that these operative procedures could be highly effective in preventing Venous Reflux. Moreover, Venous Reflux, if not corrected, leads to worsening of the results. Excellent results were consistently achieved by preventing Venous Reflux. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
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External valvuloplasty for subcutaneous small veins to prevent Venous Reflux in lymphaticovenular anastomosis for lower extremity lymphedema.
Plastic and reconstructive surgery, 2013Co-Authors: Shinsuke Akita, Hideki Tokumoto, Yoshitaka Kubota, Motone Kuriyama, Nobuyuki Mitsukawa, Masakazu Hasegawa, Tomoe Koizumi, Tatsuya Ishigaki, Kaneshige SatohAbstract:BACKGROUND: Subcutaneous ecchymosis caused by Venous Reflux is a preventable complication following lymphaticovenular anastomosis. The authors developed a series of operative procedures to prevent Venous Reflux. This is probably the first report on valvuloplasty for small subcutaneous veins (diameter,
Fedor Lurie - One of the best experts on this subject based on the ideXlab platform.
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Venous Reflux in the great saphenous vein is driven by a suction force provided by the calf muscle pump in the compression-decompression maneuver.
Journal of vascular surgery. Venous and lymphatic disorders, 2020Co-Authors: Roman A. Tauraginskii, Fedor Lurie, Sergei S. Simakov, Rishal AgalarovAbstract:Abstract Objective The gravitational pressure gradient is considered the driving force of Venous Reflux. The results from our previous study demonstrated that gravitational force is not a necessary condition for the occurrence of Venous Reflux. We hypothesized that a force exists in addition to gravity that drives Venous Reflux. The present study was designed to test this hypothesis by measuring the acceleration of blood flow during Venous Reflux in a clinical study and by simulating Reflux ex vivo in physical models. Methods A total of 80 lower extremities of 80 patients with primary incompetence of the great saphenous vein were included in the present study. The cross-sectional area of the great saphenous vein, peak velocity of Venous Reflux (PV), and time required to achieve the PV (Δt, seconds) were measured on duplex ultrasound scans taken with the patient in the standing rest position. Noncycling operator-dependent distal cuff inflation–deflation was used as the Reflux provoking maneuver. The acceleration of Venous Reflux (aReflux) was calculated as aReflux = PV/Δt in m/s2. Physical models were used to demonstrate the difference in acceleration between the free-fall stream and the flow forced by suction. Results The magnitude of aReflux was greater than gravity in 24 of 80 extremities (30%), with a range of 9.83 to 24.13 m/s2. The maximum observed value of aReflux was approximately 2.5g (24.13 m/s2). The aReflux weakly, but statistically significant inversely, correlated with the subject height (r = −0.26; P = .001). The difference in water flow acceleration was 2.5 times between the free-fall model and suction model (9.07 ± 0.2 m/s2 vs 23.32 ± 2.6 m/s2, respectively). Conclusions The acceleration of blood flow during Reflux exceeded the value of gravitational acceleration, suggesting the action of an additional nongravitational force. The calf muscle pump might create such force by negative pressure during muscle diastole.
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Anatomical Extent of Venous Reflux
Cardiology and Therapy, 2020Co-Authors: Fedor LurieAbstract:Despite the recognition of the importance of the anatomical extent of Venous Reflux, its description in medical literature is inconsistent in terms and classifications. Recent international consensus documents provide clear definitions for the three main classes of Reflux: segmental, multi-segmental, and axial. This report addresses the most important aspects of the standard definitions of the anatomical extent of Venous Reflux, the differences between the three classes of Reflux, and the challenges of implementing this classification in clinical practice.
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The immediate effect of physical activity on ultrasound-derived Venous Reflux parameters.
Journal of vascular surgery. Venous and lymphatic disorders, 2019Co-Authors: Roman A. Tauraginskii, Sergei S. Simakov, Denis Borsuk, Konstantin Mazayshvili, Fedor LurieAbstract:Abstract Objective Ultrasound-derived Reflux volume (RV) has a low correlation with the clinical severity of chronic Venous disease, as well as other hemodynamic parameters. The difference in methodology of measurements could be a possible explanation. The purpose of this study was to investigate the immediate effect of calf pump activity used in the functional methods on ultrasound-measured Venous Reflux parameters. Methods Patients with primary incompetence of the great saphenous vein (GSV) were recruited for the study. The diameter of the GSV, cross-sectional area in square centimeters, time average velocity in centimeters per second, and Reflux duration (RT) in seconds were measured by duplex ultrasound examination. The RV flow rate (Q) in milliliters per second and RV in milliliters were calculated. The measurements were performed standing at rest before and 60 seconds after physical exercise (30 lifts to tiptoes at a frequency of 1 time per second). A decrease in the volume of Reflux after exercise was calculated (DRV = RV [after] – RV [before]/RV [before] × 100%.) Automatic distal compression-decompression (120 mm Hg) was used as a provocation maneuver. Results There were 61 patients included in the study. Before exercise, Reflux parameters were: RT = 4.85 seconds (interquartile range [IQR], 3.71-6.00 seconds); Q = 3.89 mL/second (IQR, 2.03-5.81 mL/second); and RV = 17.05 mL (IQR, 10.32-25.34 mL). After physical exercise, they changed to RT = 2.86 seconds (IQR, 2.14-3.33 seconds); Q = 3.61 mL/second (IQR, 2.06-6.37 mL/second); RV = 10.07 mL (IQR, 6.08-16.48 m:); and DRV = 40.9%. The changes in RT and RV values were statistically significant. DRV was inversely related to both the GSV diameter and the Venous Clinical Severity Score (r = −0.56, and r = −0.41, respectively; P Conclusions Venous Reflux decreases within 1 minute after the end of the exercises. Reduction of the volume of retrograde flow occurs only owing to the shortening of Reflux time, and not the flow rate, suggesting that Venous Reflux is influenced by exercise-induced changes in the volume of the Venous reservoir.
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Multicenter assessment of Venous Reflux by duplex ultrasound
Journal of vascular surgery, 2011Co-Authors: Fedor Lurie, Nicos Labropoulos, Robert L. Kistner, Bo Eklof, William A Marston, Anthony J. Comerota, Mark H. Meissner, Joann M. Lohr, Gregory L. Moneta, Peter NeglénAbstract:Objective This prospective multicenter investigation was conducted to define the repeatability of duplex-based identification of Venous Reflux and the relative effect of key parameters on the reproducibility of the test. Methods Repeatability was studied by having the same technologist perform duplicate tests, at the same time of the day, using the same Reflux-provoking maneuver and with the patient in the same position. Reproducibility was examined by having two different technologists perform the test at the same time of the day, using the same Reflux-provoking maneuver and with the patient in the same position. Facilitated reproducibility was studied by having two different technologists examine the same patients immediately after an educational intervention. Limits of agreement between two duplex scans were studied by changing three elements of the test: time of the day (morning vs afternoon), patient's position (standing vs supine), and Reflux initiation (manual vs automatic compression–decompression). Results The study enrolled 17 healthy volunteers and 57 patients with primary chronic Venous disease. Repeatability of Reflux time measurements in deep veins did not significantly differ with the time of day, the patient's position, or the Reflux-provoking maneuver. Reflux measurements in the superficial veins were more repeatable ( P P Conclusions This study provides evidence to develop a new standard for duplex ultrasound detection of Venous Reflux. Reports should include information on the time of the test, the patient's position, and the provoking maneuver used. Adopting a uniform cut point of 0.5 second for pathologic Reflux can significantly improve the reliability of Reflux detection. Implementation of a standard protocol should elevate the minimal standard for agreement between repeated tests from the current 70% to at least 80% and with more rigid standardization, to 90%.
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How often is deep Venous Reflux eliminated after saphenous vein ablation
Journal of vascular surgery, 2003Co-Authors: Alessandra Puggioni, Fedor Lurie, Robert L. Kistner, Bo EklofAbstract:Abstract Background and purpose Deep Venous Reflux resolution after great saphenous vein surgery has been reported, but the studies evaluated mainly patients with deep segmental Reflux. We prospectively analyzed the effects of greater saphenous vein ablation on coexisting primary deep axial Venous Reflux compared with segmental Venous Reflux. Patients and methods Between February 1997 and June 2001, patients with primary deep Venous Reflux scheduled for greater saphenous vein surgery were included in the study. Limbs of patients with a history of deep Venous thrombosis, thrombophlebitis, trauma, and orthopedic or Venous surgery were excluded. After surgery, duplex scanning was repeated and patients were examined for persistent deep Venous Reflux. Results Thirty-three patients (38 limbs) were followed up with duplex scanning. Follow-up ranged from 2 weeks to 38 months. Preoperative axial deep Reflux was present in 17 extremities, and segmental Reflux was present in 21. The total number of incompetent segments was 59. Overall Reflux abolishment rate was similar in extremities with axial and segmental Reflux (30% vs 36%; P > .05). When segments were analyzed individually, abolishment of superficial femoral vein Reflux was observed more often in extremities with segmental Reflux than those with axial Reflux (odds ratio, 4). In the extremities where deep Reflux was not abolished with greater saphenous vein ablation, degree of Reflux did not change significantly ( P > .1). Duplex scanning was performed more than once during follow-up in 9 patients. In 3 of these patients Reflux resolved by the second follow-up evaluation, and in 2 Reflux was decreased at the second and third follow-up evaluations. Conclusion In patients with concomitant deep and superficial Venous Reflux, saphenous vein ablation results in resolution of deep Reflux in about a third of patients. Superficial femoral vein Reflux is seldom corrected in limbs with axial Reflux compared with those limbs with segmental Reflux. To appreciate the effects of greater saphenous vein ablation, longer follow-up may be needed.
