Preoperative duplex-derived parameters and angioscopic evidence of valvular incompetence associated with superficial venous insufficiency

Purpose: To determine if an association exists between duplex-derived parameters and intraoperative angioscopic findings of valvular incompetence. Methods: Preoperative duplex scanning and intraoperative angioscopy were performed on 153 limbs in 116 patients (84 women; mean age 53 years, range 24-79) with superficial venous incompetence (SVI). The duplex parameters of vein diameter at the saphenofemoral junction (SFJ), reflux duration, and peak retrograde reflux velocity at the SFJ were analyzed among SVI patients categorized by intraoperative angioscopy as type I (valves with elongated and atrophic cusps), type II (valves with expanded and depressed commissures with cusp changes), type III (cusps with other deformities), or type IV (absent valves). Results: There were 33 limbs with type I valves, 56 with type II, 25 with type III, and 39 with type IV. Among the 89 limbs with type I or II valves, 64 (71.9%) had a peak velocity <30 cm/s, while only a quarter of the limbs with type III or IV values had a velocity <30 cm/s. The majority of patients with types I or II valves had a vein diameter <0.9 cm (25 [75.8%] type I and 37 [66.1%] type II). The sensitivity, specificity, and predictive value for identifying type I and II valve lesions were maximized at 90.0%, 66.7%, and 77.8%, respectively, when vein diameter <0.9 cm was combined with a peak reflux velocity >30 cm/s. Conclusions: These data suggest that a combination of variables determined by preoperative duplex scans may correlate to the severity of valvular deformity determined by direct angioscopic inspection.