Patterns of reflux in patients with CEAP C2 disease compared to patients with C6 venous ulceration

Objective

CEAP categorizes patients based on disease progression and severity. Whether disease severity is associated with specific patterns of reflux is currently unknown. We hypothesize that patterns of reflux in patients with C2 and C5/6 disease will differ.

Design

Multi-center retrospective cohort analysis.

Methods

From January 2015 to December 2020, we performed a retrospective review of reflux patterns in 21 335 patients and 31 727 limbs in symptomatic patients with C2 or C5/6 disease. Patterns of reflux in Great (GSV), Small (SSV), Deep and Perforators (Perf), were analyzed in patients with and without junctional reflux. The GSV and SSV were divided into six and three segments respectively. The number of perforators with reflux were categorized as 1-3 above and below-knee and deep system reflux was divided into three segments.

Results

Of the 21 335 patients the average age and female/male distribution was the following: C2 (54.13 ± 13.82, 21 410/5047), C5/6 (64.75 ± 14.75, 1514/1755) (p ≤ .001). When SFJ reflux is present, 6-segment GSV reflux was most prevalent (C2, 14.85% vs C5/6, 27.50). Without junctional reflux, above knee reflux was more common in C2 disease, while below knee reflux was more common in C5/6 disease (p ≤ .01). Three segment SSV reflux was more prevalent in C2 patients (26.67% vs 16.27%, p ≤ .001). Below knee perforator reflux was more prevalent in C5/6 patients (79.56% vs 73.53%, p ≤ .01). Combined CFV/FV/POPV reflux was more prevalent in C5/6 patients (38.5% vs 20.5%, p ≤ .001).

Conclusion

The presence of junctional reflux is more closely associated with disease location (above- vs below-knee) than with disease classification. SFJ reflux is more likely to present with extensive above knee disease. Isolated below-knee reflux is more significantly associated with C5/6 disease, independent of junctional reflux. Conversely, isolated above-knee superficial reflux is significantly associated with C2 disease and junctional reflux.