Labropoulos N, Giannoukas A D, Delis K, Mansour M A, Kang S S, Nicolaides A N, Lumley J, Baker W H
Division of Peripheral Vascular Surgery, Loyola University Medical Center, Maywood, Ill. 60153-3304, USA.
J Vasc Surg. 1997 Nov;26(5):736-42. doi: 10.1016/s0741-5214(97)70084-3.
This study was designed to identify the origin of lower limb primary venous reflux in asymptomatic young individuals and to compare patterns of reflux with age-matched subjects with prominent or clinically apparent varicose veins.
Forty age- and sex-matched subjects with no symptoms (age, 15 to 35 years; 80 limbs; group A), 20 subjects (age, 19 to 32 years; 40 limbs) with prominent but nonvaricose veins (n = 26 limbs; group B), and 50 patients (age, 17 to 34 years; 100 limbs) with varicose veins (n = 64; group C) were examined with color flow duplex imaging. All proximal veins (above popliteal skin crease), superficial, perforator, and deep, in the lower limb were examined in the standing position, and all the distal veins in the sitting position. Patients who had a documented episode of superficial or deep vein thrombosis, previous venous surgery, or injection sclerotherapy were excluded from the study.
The prevalence of reflux in group A was 14% (11 of 80), in group B 77% (31 of 40), and in group C 87% (87 of 100). In more than 80% of limbs in the three groups, reflux was confined to the superficial veins alone. Deep venous reflux or combined patterns of reflux were uncommon even in group C. Reflux was detected in all segments of the saphenous veins and their tributaries. In the 125 limbs that had superficial venous incompetence, the below-knee segment of the greater saphenous vein was the most common site of reflux (85, 68%), followed by the above-knee segment of greater saphenous vein (69, 55%) and the saphenofemoral junction (41, 32%). Nonsaphenous reflux was rare (3, 2.4%). Reflux in the lesser saphenous vein (21, 17%) was seen in all groups, whereas involvement of both greater and lesser saphenous veins (8, 6.4%) was seen in group C alone. The incidence of multisegmental reflux was significantly higher in group C (61 of 64, 95%) than in group A (two of 11, 18%) or group B (14 of 26, 54%). The prevalence of distal reflux was comparable in all groups.
Primary venous reflux can occur in any superficial or deep vein of the lower limbs. The below-knee veins are often involved in asymptomatic individuals and in those who have prominent or varicose veins. These data suggest that reflux appears to be a local or multifocal process in addition to or separate from a retrograde process.
本研究旨在确定无症状年轻个体下肢原发性静脉反流的起源，并将反流模式与年龄匹配的有明显或临床可见静脉曲张的受试者进行比较。
40名年龄和性别匹配且无症状的受试者（年龄15至35岁；80条肢体；A组），20名有明显但无静脉曲张的受试者（年龄19至32岁；40条肢体）（26条肢体；B组），以及50名有静脉曲张的患者（年龄17至34岁；100条肢体）（64条；C组）接受了彩色多普勒成像检查。所有下肢近端静脉（腘窝皮肤皱襞上方）、浅静脉、穿静脉和深静脉均在站立位进行检查，所有远端静脉在坐位进行检查。有浅表或深静脉血栓形成记录、既往静脉手术或注射硬化治疗史的患者被排除在研究之外。
A组反流发生率为14%（80条中的11条），B组为77%（40条中的31条），C组为87%（100条中的87条）。三组中超过80%的肢体反流仅局限于浅静脉。即使在C组，深静脉反流或联合反流模式也不常见。在大隐静脉及其属支的所有节段均检测到反流。在125条有浅静脉功能不全的肢体中，大隐静脉膝下段是最常见的反流部位（85条，68%），其次是大隐静脉膝上段（69条，55%）和隐股交界处（41条，32%）。非大隐静脉反流很少见（3条，2.4%）。所有组均可见小隐静脉反流（21条，17%），而仅C组可见大隐静脉和小隐静脉均受累（8条，6.4%）。C组多节段反流的发生率（64条中的61条，95%）显著高于A组（11条中的2条，18%）或B组（26条中的14条，54%）。所有组远端反流的发生率相当。
原发性静脉反流可发生于下肢任何浅静脉或深静脉。膝下静脉在无症状个体以及有明显或静脉曲张的个体中常受累。这些数据表明，反流似乎是一个局部或多灶性过程，是逆行过程之外或与之分开的过程。
