Relation Between Superficial Vein Reflux and Deep Vein Disease: Clinical Impact of Modern Treatment

Chronic venous disease (CVD) is the most prevalent form of vascular disease, affecting about a third of adult Americans. Most patients present with varicose veins but swelling and skin damage are common as well. The signs and symptoms of CVD are result of venous hypertension that develops from reflux, obstruction or a combination of both. In patients with CVD, around 70-80% will have superficial reflux with or without perforator vein incompetence and 10% isolated deep reflux. Combined superficial and deep vein disease has been reported to occur in about 10-20%. Congenital CVD and chronic venous obstruction are rare (Figure 1). While treatment of the isolated s u p e r f i c i a l venous system in patients with CVD is expected and has been shown to have good outcomes, the role, efficacy and compl ica t ions of superficial intervention in patients with c o m b i n e d disease has been con t rove rs ia l . In patients with mixed pathology, deep venous obstruction occurs in a small number of limbs, which is either primary or secondary. The majority though, will have underlying reflux which will be segmental and is likely to occur due to volume overload from the recirculating reflux blood in the superficial veins. However, axial vein reflux, which is most often a result of previous thrombosis, also is seen, as about two thirds of patients with proximal vein thrombosis will develop reflux at one year. Patients with a previous episode of thrombosis may have vein segments without or with partial recanalization leading to obstruction or to a combination of reflux and obstruction.