Correlation of perforating vein incompetence with extent of great saphenous insufficiency: cross sectional study.

Aim: To explore the correlation between perforating vein incompetence and the extent of great saphenous vein insufficiency according to Hach.

Methods: Duplex ultrasound was used to determine the number of incompetent perforators and diameter of perforating veins, and the level of great saphenous vein reflux and the presence or absence of deep reflux in 118 lower limbs (59 patients). There were 19 limbs with no clinical evidence of venous disease (CEAP - clinical, etiological, anatomical, pathological grade 0), 16 limbs with telangiectasias only (CEAP grade 1), 36 limbs with varicose veins (CEAP 2), 26 limbs with edema (CEAP 3), and 21 limb affected with lipodermatosclerosis but not ulcer (CEAP 4).

Results: Both the number of incompetent perforators and the average diameter of duplex detectable perforators per limb correlated significantly with the extent of great saphenous vein insufficiency (Pearson correlation coefficients were 0.55 and 0.44, respectively; P<0.001 for both). The number of incompetent perforators and the average diameter of perforators per limb were significantly higher with the deteriorating CEAP grade (Kruskal-Wallis H test; P<0.001). The mean number of incompetent perforators per limb did not differ significantly in the absence or presence of deep reflux (0.8-/+1.26 vs 1.3-/+1.6, t test, P=0.172), the average diameter of perforators per limb was higher in the presence of deep reflux (2.4-/+2 mm vs 3.7-/+1.1 mm, t test, P=0.023).

Conclusion: The extent of great saphenous vein insufficiency correlated with an increase in the number and the diameter of perforators. The perforators' association with deep venous reflux was much poorer. Clinical presentation worsened with the deteriorating duplex signs of perforators' incompetence.