Effect of Varicose Vein Surgery on Venous Reflux Scoring and Plethysmographic Assessment of Venous Function

Background: Colour duplex ultrasonography (CDU) is widely recommended before varicose vein surgery, combined with quantification of venous reflux by plethysmography where required. This study assessed venous haemodynamics before and after varicose vein surgery by venous outflow plethysmography (VOP), venous reflux plethysmography (VRP) and by adoption of a modified segmental venous reflux score (VRS). The effect of wearing one or two class I medical compression stockings was also assessed. The aim of the study was to identify parameters which reflect the outcome of treatment using medical compression stockings or surgical intervention. Methods: 24 legs of 21 patients with superficial vein incompetence of clinical grade C2-4a (CEAP) were assessed before and a mean of 8 S.D. 4 months after superficial vein surgery. Investigations were CDU, as well as VOID and VRP using mercury in rubber gauges fitted either around the calf or the forefoot. Venous reflux was semi-quantitatively graded by CDU in relation to the actual vein diameter and transformed into a VRS with respect to the number of involved serial vein segments. The venous reflux rates were measured in standing patients after knee bending before and after application of one or two superimposed compression stockings (class 1). Results: According to VRP, one compression stocking reduced the maximum venous reflux rates (VRmax) by about 30% which was comparable with the effect of surgery on VRmax. Two superimposed compression stockings were almost twice as effective and diminished VRmax pre- and post operatively by around 60%. Varicose surgery reduced the maximum venous outflow rates significantly (pre-op: 166 S.D. 77 ml/min x 100 ml tissue, post op: 120 S.D. 34) and improved VRS (pre-op median 5.0 IQR: 4.5-5.5, post-op median 0.5 IQR: 0-1.0). Surgery had no effect on venous refitting time or venous reflux rates when measured without compression stockings. Conclusion: Venous reflux assessed by plethysmography was moderated by the use of compression stockings pre-operatively but did not reflect the outcome of surgical treatment of superficial venous reflux. Increased venous volume and venous outflow were restored to the levels of normal contralateral limbs by surgery. The VRS decreased considerably following surgery, reflecting the effect of surgical treatment on the number of incompetent venous segments. Changes in this parameter did not correlate with any of the plethysmographic measurements. (C) 2008 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.