Background: Patients with chronic venous disease (CVD) often ask whether elective vein surgery could be delayed without consequences. Because the natural history of CVD is not well known, this study was designed to determine its progression in such patients.
Methods: One hundred and sixteen limbs in 90 patients who had at least 2 exams with duplex ultrasound (DU) scanning prior to vein surgery at a university medical center were studied. These were patients who were offered an operation but for various reasons were treated at a later stage. Patients were classified by the CEAP system.
Results: The mean age of the patients was 49 years (range, 23 to 81 years). A second DU scan was performed 1 to 43 months after the initial exam (median, 19 months). Eighty-five limbs (73.3%) were unchanged. Thirteen limbs (11.2%) had progression of clinical stage, and seven had progression on DU scanning as well. Seven limbs progressed from C2 to C3, four limbs from C3 to C4, and two limbs from C4 to C6. Thirty-four limbs had a documented change on repeat DU scanning. In 3 of these limbs, reflux was missed on the initial exam; therefore, 31 limbs had progression of disease. The great saphenous vein and tributaries were the most often anatomic sites affected by a change, followed by perforators. Seventeen limbs (14.7%) had extension of pre-existing reflux, and 14 (12.1%) had reflux in a new segment. In 11 of these limbs, a change in the initial plan for treatment was required. Symptomatic or DU changes were noted 6 months or later in 95% of limbs and 74.2% of limbs with disease progression were diagnosed at 12 months or later. All but one of the 13 symptomatic limbs developed symptoms at least a year later.
Conclusion: Nearly one third of patients with venous reflux had progression. Anatomic extension is frequent with disease progression but not a pre-requisite. Progression was found in most limbs 6 months after the initial study. Patients undergoing treatment for their veins may need another DU exam if this time interval is exceeded.