Inflammation parallels severity of chronic venous insufficiency

Objective: This study was designed to assess the haemodynamic flow changes in patients with chronic venous insufficiency (CVI). Methods: Duplex scanning was used to evaluate prospectively the flow characteristics in the lower limb circulation and the number of enlarged lymph nodes in the groin of normal subjects, patients with CVI classes 2, 4, 5 and 6, and patients with acute cellulitis. Phasicity and continuous flow patterns were assessed in the venous system, while the arterial system was evaluated for tri-phasic flow, absence of flow reversal and absence of flow reversal with hyperaemic flow (increased peak systolic and end diastolic velocities). Additionally, the number and size of the groin lymph nodes around the saphenofemoral junction were recorded. Results: Patients with more severe class 4-6 CVI demonstrated an increased prevalence of abnormal flow patterns within the venous system of the leg compared to the normal phasic flow pattern seen in the absence of disease (P<0.001). Within the arterial system, significant changes were also observed in all three arteries studied in the legs of patients with class 4-6 CVI (P<0.001). For both the arterial and venous systems, no difference was noted between control limbs vs class 2 diseases or class 4-6 diseases vs cellulitis. With respect to the evaluation of inguinal lymph nodes, patients with class 2 disease were approximately four times as likely to have positive lymph nodes, and patients with more severe CVI were approximately 13 times as likely to have significant lymph nodes present. Conclusions: This study demonstrated that patients with more advanced stages of CVI had arterial and venous flow increases similar to those seen in an acute inflammatory condition such as cellulitis. These changes were most pronounced in the perforating and subcutaneous vessels in the leg.