Hemodynamic patterns of reflux in primary sapheno-popliteal junction incompetence

Duplex ultrasound investigation (DUI) has considerably improved the diagnosis of anatomical venous variations in the popliteal region: however, some pitfalls still remain concerning the hemodynamics of incompetent sapheno-popliteal junctions (SPJs). Aims of this study were to assess the prevalence rates of the hemodynamic patterns of reflux, either diastolic or systolic or both, in a large series of patients with SPJ incompetence, and to analyze the origin of the systolic components of the reflux. Four hundred and fiftythree patients, 83 males and 370 females, mean age 58.0 years±SD 13.8 with primary SPJ incompetence (512 limbs) underwent preoperative DUI using the Paranà manoeuvre, a dynamic test able to develop systolic and diastolic pressure gradients through the reflex activation of muscle pumps. Of the 512 incompetent SPJs, 420 showed isolated diastolic reflux, 9 isolated systolic reflux and 83 systolic reflux followed by diastolic reflux. Altogether, 92 SPJs over 512 (18%) showed a systolic component of the reflux, which originated from the popliteal vein in 78 cases (15%) and from the gastrocnemius veins (GVs) in 14 cases (3%). In these latter cases, the short saphenous vein and one or more GVs showed a common trunk. Our findings show that the detection of a systolic component of the reflux in incompetent SPJs is not an uncommon event and suggest that treatment strategy should be differentiated according to the origin of the systolic reflux, given their different hemodynamic behavior.