Direction of flow in superficial veins as a guide to venous disorders in lower limbs.

Clinical methods and directional Doppler velocimetry applied to superficial veins have been used to study 527 patients with venous disorders in the lower limbs. Phlebography assisted by the image intensifier has been carried out in 80 of these patients. All examinations have been done with the patient upright, exercising, and without use of any artefact, such as a tourniquet. By these combined means Doppler flow patterns in the superficial veins of five groups of patients have been identified: (1) a highly distinctive downward flow in the upright exercising patient (retrograde circuit) in simple incompetence of the superficial veins (82.1%); (2) a characteristic pattern of upward flow accentuated by exercise, indicating collateral function past deep veins impaired by previous thrombosis (postphlebitic syndrome) (5.7%); (3) a surge back and forth on exercise in patients with valveless deep veins, probably of cogenital origin (8%); (4) sustained upward flow, accentuated by exercise, in veins acting as collaterals to occluded iliac veins (1.5%); (5) a variety of flow patterns in congenital states, including Klippel-Trenaunay syndrome (2.7%). Approximately one half of patients with venous stasis were in the first group and therefore probably had curable conditions; the remainder had the deep vein problems. The incidental role of the "perforator" is discussed and attention drawn to the significance of the retrograde circuit based upon the foot. The directional Doppler flowmeter provides an important screening test that positively identifies simple superficial vein incompetence, suitable for treatment, or gives clear warning of unsatisfactory deep veins that should be investigated further.