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Abstract
The anatomy, valvular function, and reflux patterns in the deep veins of the lower
extremities were studied by ascending and descending phlebography in 126 limbs with
nonthrombotic deep venous incompetence. The most common patterns were isolated reflux
in the superficial femoral vein (51%), and combined reflux in the superficial femoral
and the deep femoral veins (44%). Isolated deep femoral vein reflux occurred in 5%.
As the degree of reflux in this vein varied considerably, a grading system for classification
of deep femoral vein reflux was proposed. Depending on variations in the deep femoral
vein anatomy, four different patterns could be distinguished. This study demonstrated
that contrast filling of the deep femoral vein during ascending phlebography may indicate
the presence of reflux in this vein. Complete visualization of the deep femoral vein
is a new diagnostic sign that strongly correlates (p less than 0.001) with reflux
in the deep femoral vein. The mean number of valves in the superficial femoral vein
was reduced with increasing degree of reflux compared with a reference group consisting
of 41 extremities without reflux. The diameter of the popliteal vein was significantly
increased in the presence of pathologic reflux, which may indicate that vein wall
dilation is a major cause of primary nonthrombotic deep venous incompetence.