gms | German Medical Science

Background: Reflux plays an important role in the physiology of chronic venous insufficiency (CVI). Our study investigates whether patients with an asymptomatic pathological reflux in one leg exhibit a higher occurrence of CVI in the same leg as subjects without pathologic reflux.

Material and methods: Data are derived from the Bonn Vein Study, a population-based cohort study (2000–2008) which included 3072 participants between 18 and 79 years, residing in Bonn and two rural adjacent townships. Reflux is operationalized as prolonged time to valve closure and measured by duplex-sonography in single vein segments, segment combinations (axial veins and thigh veins), superficial (great saphenous thigh, great saphenous knee and small saphenous vein) and the deep vein system (posterior tibial vein, femoral vein, popliteal vein). Venous diseases were judged by CEAP-classification. We calculated age-adjusted CVI incidence, defined for each limb categorised between C3 and C6, in each limb according to reflux status.

Results: Response at follow-up after a mean of 6.6 years was 84.6%. 1140 men and 1407 women showed no signs of CVI at baseline. At follow-up, 192 cases of new CVI were diagnosed in right legs and 202 in left legs. Participants with reflux in the superficial vein system, segments and axial veins had higher incidences of CVI for each leg. CVI incidence in the right leg was 26% (95%-CI:18%,34%) if there was a reflux in at least one superficial vein segment and 10% (95%-CI:8%,11%) otherwise. For a reflux in the superficial axial veins CVI incidence for the right leg was slightly higher with 31% (95%-CI:18%,44%) and 10% (95%-CI:8%,12%) otherwise. Reflux in deep veins did not consistently influence CVI incidence. Differences between right and left legs were small.

Discussion: Reflux in superficial veins could play a role in the development of CVI, this is observed especially for a reflux in superficial axial veins.