Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Nov;12(6):101946.
doi: 10.1016/j.jvsv.2024.101946. Epub 2024 Jul 16.

A systematic review of anatomical reflux patterns in primary chronic venous disease

Matthew K H Tan  1 , Roshan Bootun  2 , Roy Wang  1 , Sarah Onida  1 , Tristan Lane  2 , Alun H Davies  3
Affiliations
Meta-Analysis

A systematic review of anatomical reflux patterns in primary chronic venous disease

Matthew K H Tan et al. J Vasc Surg Venous Lymphat Disord. 2024 Nov.

Abstract

Objective: Patients with chronic venous disease (CVD) can present with different underlying hemodynamic abnormalities affecting the deep, superficial, and perforator veins. This review explores the relationship between reflux patterns, extent of venous reflux, and clinical manifestations of CVD.

Methods: The Medline and EMBASE databases were searched systematically from 1946 to April 1, 2024. References of shortlisted papers were searched for relevant articles. Studies were included if they were in English language, included participants ≥16 years of age, documented reflux patterns in two or more of the following: deep, superficial, and/or perforator systems, and related patterns to presentation or severity. Exclusion criteria included patients with isolated deep venous thrombosis, post-thrombotic syndrome or stenotic or obstructive disease.

Results: We identified 18 studies (11,177 participants; range, 55-3016). Meta-analysis showed significant odds ratios (OR) for C4-6 disease being associated with deep reflux (OR, 2.41; 95% confidence interval [CI], 1.53-3.78) and perforator reflux (OR, 3.37; 95% CI, 2.16-5.27), but not superficial reflux (OR, 2.11; 95% CI, 0.87-5.14), vs C0-3 disease. Severe CVD (C4-6) was significantly associated with isolated deep, combined deep and superficial, and combined superficial and perforator reflux. The greatest risk of CVD progression (defined as de novo development of varicose veins and progression to greater CVD severity) was shown by two studies to be related to combined deep and superficial reflux.

Conclusions: Although limited by the heterogenous nature of the studies, this review confirms that reflux pattern is a significant predictor of clinical class, and higher clinical, etiological, anatomical, and pathophysiological stages are associated with a higher prevalence of superficial, deep, and perforator reflux. Isolated deep and combined reflux also seem to be to predict the onset of leg ulceration. Future studies should relate reflux patterns to treatment outcomes, including recurrence risk. This work could help to inform health policies and management guidelines so that reflux patterns, in conjunction with other demographic and hemodynamic parameters, could be used to risk stratify patients and identify individuals who may benefit from earlier treatment.

Keywords: Anatomy; Chronic venous disease; Veins; Venous insufficiency.

PubMed Disclaimer

Conflict of interest statement

Disclosures None.

Figures

Fig 1
Fig 1
PRISMA diagram.
Fig 2
Fig 2
Forest plots illustrating presence of deep, perforator, and superficial reflux in C4-6 vs C0-3 patients. CI, confidence interval; M-H, Mantel-Haenszel.
Fig 3
Fig 3
Summary of key findings from the available literature on reflux patterns and their relationships to chronic venous disease (CVD).
See this image and copyright information in PMC

References

    1. Laing W. Office of Health Economics; 1992. Chronic venous diseases of the leg.
    1. Rabe E., Pannier F. Societal costs of chronic venous disease in CEAP C4, C5, C6 disease. Phlebology. 2010;25(Suppl 1):64–67. - PubMed
    1. Widmer L.K. Prevalence and sociomedical importance. Basel III Study Bern; 1978. Peripheral venous disorders; pp. 43–50.
    1. Wittens C., Davies A.H., Baekgaard N., et al. Editor’s Choice - management of chronic venous disease: clinical practice guidelines of the European society for Vascular Surgery (ESVS) Eur J Vasc Endovasc Surg. 2015;49:678–737. - PubMed
    1. Gloviczki P., Comerota A.J., Dalsing M.C., et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Suppl):2S–48S. - PubMed

LinkOut - more resources