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Is there a saphenous vein diameter cut off point for venous reflux screening ?

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    Is there a relationship between saphenous vein size and venous reflux ? 

    Article written by Jean Francois Gutierrez MD
    Private Practice, Dubai
    Medical Contributor for Vein News and www.VeinsVeinsVeins.co


    Study Background:

    Researchers have always wondered if there is a "cut off point" below which saphenous reflux should not be considered to exist. 

    What was the study hypothesis ?

    Researchers put this hypothesis to the test at the Department of Diagnostic and Therapeutic Radiology at the Ramathibodi Hospital in Bangkok, Thailand.  The research was published in Phlebology (see reference below). 


    Study Methods:

    A retrospective cohort study in 807 limbs over 36 months. 



    What was the study population ? 

    C0 - C3 patients.  Namely C0 have no venous disease;  C1 have spider veins; C2 have varicose veins; C3 have edema of venous origin. 


    What are the results ? 

    The authors measured diameter of the great saphenous vein at four levels and the small saphenous vein at 2 levels. 

    The reflux positive group had larger diameter than the non reflux group at 4 levels in the great saphenous vein and at 2 levels in the small saphenous vein. 

    Venous reflux correlated significantly with vein diameter at 4 GSV locations and at 2 small saphenous vein locations. 

    What are the optimal cut off diameters for the GSV for reflux ? 

    The optimal cut off diameter for the GSV was 3.8 mm in the proximal thigh and 2.8 mm in the distal thigh.

    The optimal cut off diameter for the GSV below knee segment is 3.2 mm in the proximal calf and 2.5 mm in the distal calf. 



    What are the optimal cut off diameters for small saphenous vein reflux ? 

    The optimal cut off diameter for the small saphenous vein was 2.5 mm in the proximal calf and 2.3 mm in the distal calf.


    What are the study conclusions ?

    The study shows that saphenous vein diameter is correlated to the degree og reflux. 

    The authors could not conclude that there was a cut off diameter that excluded the presence of reflux.  Therefore, a cut off diameter cannot be used as a screening tool to either suggest or rule out the presence of reflux in a particular saphenous vein. 

    Site Editor's comment:  This is an important study concept that needed to be validated once again.  

    REFERENCE:  Panpikoon T, Matheekul P, Treesit T, Bug-ngam C, Sriprachyakul A, Picitpichatkul K.  Diameter reflux relationshi of the saphenous vein in the C0-C3 patients of chronic venous disease.  Phlebology 2022; 36: 439-444.