BEYOND THE SAPHENOUS VEIN: A WHOLE-LEG DUPLEX STUDY OF VARICOSE REFLUX PATTERNS

Abstract

Objective: This study aimed to (1) analyze venous reflux patterns in primary versus recurrent varicose veins (VV) using whole-leg duplex ultrasonography (DUS), and (2) compare handheld Doppler (HHD) with DUS for diagnostic accuracy. Methods: A prospective observational study was conducted in saveetha medical college over 2 years (1-year recruitment, 1-year follow-up) in 200 patients (120 primary, 80 recurrent VV). Standardized DUS assessed reflux (>0.5 sec) in the great/small saphenous (GSV/SSV), perforator, and deep veins. HHD findings were compared to DUS in a subgroup (n=150). Outcomes included reflux distribution, ulceration/recurrence rates, and HHD-versus-DUS concordance (κ statistics). Results: ●Reflux patterns: GSV incompetence dominated both primary (81.7%) and recurrent VV (77.5%, p=0.48). Perforator reflux was significantly higher in recurrent cases (52.5% vs. 37.5%, p=0.03). ●Deep vein reflux: Present in 17.5% of recurrent versus 10.0% of primary cases (p=0.12). ●HHD vs. DUS: HHD showed good SFJ agreement (κ=0.76) but poor perforator detection (κ=0.42). ●1-year outcomes: Recurrent VV had higher ulceration (13.9% vs. 5.5%, p=0.04) and new reflux (30.6% vs. 16.4%, p=0.02). Perforator reflux predicted ulceration (OR=2.4, p=0.006). Conclusion: GSV reflux is the most common pattern, but perforator incompetence drives recurrence and ulceration. DUS remains superior to HHD for comprehensive mapping, particularly for perforators. Targeted perforator treatment may improve outcomes in high-risk patients.