ABSTRACT
Neel V. Gadhoke, BS
Medical Student
Rutgers - New Jersey Medical School, New Jersey, United States
The CEAP classification system categorizes patients based on disease progression and severity. Whether disease severity is associated with specific patterns of reflux is currently unknown. We hypothesize that patterns of reflux in patients with C2 disease will differ from those in patients with C5/6, regardless of the presence of junctional reflux, and that junctional reflux may not correlate with disease severity.
Methods:
From January 2015 to December 2020, we performed a retrospective review of 162,000 patients and analyzed the reflux patterns of 30,881 limbs in symptomatic patients with C2 or C5/6 disease. Patterns of reflux in Great Saphenous Vein (GSV), Small Saphenous Vein (SSV), Deep Veins (CFV, FV, PV), and Perforators (Perf), were analyzed in patients with and without junctional reflux. Reflux was categorized into number of segments above-knee and below-knee.
Results:
When junctional reflux was present, reflux in all six GSV segments was more prevalent in C5/6 patients compared to C2 patients (27.4% versus 14.85%, p ≤ 0.001) Figure 1. Six segment GSV reflux without junctional reflux is still higher in C5/6 patients compared to C2 but at a lower prevalence (7.13% versus 3.64%, p ≤ 0.01). Without junctional reflux, C5/6 disease was significantly related to below-knee reflux, especially when all three calf segments were involved (p < 0.001) Figure 2. Reflux in below knee perforators was more prevalent in C5/6 patients compared to C2 patients (79.56% versus 73.53%, p≤0.01), whereas above knee perforator disease was more prevalent in C2 compared to C5/6 (14.83% versus 3.43%, p ≤ 0.001). Isolated Common and Femoral vein reflux was more prevalent in C2 patients (63.07% vs 47.01%, p ≤ 0.001). Combined Common Femoral/Femoral/Popliteal vein reflux was more prevalent in C5/6 patients (38.5% versus 20.5%, p ≤ 0.001)
Conclusions:
Isolated below-knee superficial venous reflux is more significantly associated with C5/6 disease, independent of junctional reflux. Patients with C5/6 disease, with and without junctional reflux, demonstrated a higher incidence of entire (three-segment) below-knee reflux in both the Great and Small Saphenous veins. Similarly, combined deep system reflux and below knee perforator reflux was more prevalent in patients with C5/6 disease. Conversely, isolated above-knee superficial venous reflux is more significantly associated with less severe forms of clinical venous disease (C2) and is more likely to coexist with junctional reflux.