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There are two policies. To quantify venous reflux according to halv venous
reflux times after calf compression or according to the maximum reflux
velocity. I cannot believe in long reflux half times as a valid criteria
since it is not logical to have a long venous reflux time but a fast venous
pressure equilibration to the passiv hydrostatic ones. Reflux velocities and
halv times must be seen in relation to the actual vein diameter. Kistners
lab (Gudmundsson, Eklöf et al have worked with it and also we here. I'll
give some citations dealing with venous reflux grading (anatomical grading,
reflux grading and combined anatomical and functional grading)
Best regards Reinhard

1.	Danielsson G, Arfvidsson B, Eklöf B, Kistner RL, Masuda EM, Satoc DT:
Reflux from thigh to calf, the major pathology in chronic venous ulcer
disease: surgery indicated in the majority of patients. Vasc Endovasc Surg
2004;38:209-19. 
2.	Porter JM, Moneta GL, International Consensus Committee on Chronic Venous
Disease. Reporting standards in venous disease: an update. J Vasc Surg
1995;21:635-45. 
3.	Rutherford RB, Padberg FT, Comerota AJ, Kistner RL, Meissner MH Moneta
GL. Venous severity scoring: an adjunct to venous outcome assessment. J Vasc
Surg 2000;31:1307-12.
4.	.Rutherford EE, Kianifard B, Cook SJ, Holdstock JM, Whiteley MS.
Incompetent perforating veins are associated with recurrent varicose veins.
Eur J Vasc Endovasc Surg 2001; 21:458-460 
5.	Magnusson M, Nelzén O, Volkmann R: Leg ulcer recurrence and its risk
factors: A Duplex Ultrasound study before and after vein surgery. EUR J VASC
ENDOVASC SURG 32, 453-461 (2006).
6.	Zachrisson H, Volkmann R, Bergerheim T, Holm J: Selectivity of
superficial vein occlusion at the ankle and calf level. A methodological
study in healthy volunteers. Clinical Physiology 1998;18:
7.	Christopoulos DG, Nicolaides AN, Szendro G, Irvine AT, Bull MJ, Eastcott
HHG: Air plethysmography and the effect of compression on venous
hemodynamics of the leg. J Vasc Surg 1987;5:148-59
8.	Nicolaides AN, members of the executive committee Classification and
grading of chronic venous disease in the lower limbs: a consensus statement.
In Gloviczki P, Yao JST,ed. Handbook of venous disorders. London; Chapman
and Hall; 1996, p 652-60
9.	Masuda EM, Kistner RL, Eklöf B: Prospective study of duplex scanning for
venous reflux: comparison of Valsalva and pneumatic cuff techniques in the
reverse Trendelenburg and standing positions J Vasc Surg 1994;20:711-20
10.	Danielsson G, Eklöf B, Grandinetti A, Lurie F, Kistner RL: Deep axial
reflux, an important contributor to skin changes or ulcer in chronic venous
disease. J Vasc Surg. 2003;38:1336-41. 
11.	Magnusson MB, Nelzén O, Risberg B, Sivertsson R. A Colour Doppler
Ultrasound study of venous reflux in patients with chronic leg ulcers. Eur J
Vasc Endovasc Surg 2001; 21:353-360
12.	Magnusson M, Kälebo P, Lukes P, Sivertsson R, Risberg B. Colour Doppler
ultrasound in diagnosing venous insufficiency. A comparison to descending
phlebography. Eur J Vasc Endovasc Surg 1995; 9:437-443
13.	Kakkos SK, Rivera MA, Matsagas MI, Lazarides MK, Robless P, Gianni
Belcaro G et al: Validation of the new venous severity scoring system in
varicose vein surgery J Vasc Surg 2003;38:224-8. 
14.    Volkmann E . Falk, J. Holm, B. Philipson, B. Risberg, R. Volkmann:
Effect of Varicose Vein Surgery on Venous Reflux Scoring and
Plethysmographic Assessmentof Venous FunctionEur J Vasc Endovasc Surg (2008)
36, 731e737


On Thu, 14 May 2009 12:07:51 -0400, Jessica Freedman <[log in to unmask]> wrote:

>What protocol are others using to grade the severity of venous insufficiency? 
>
>Thanks!
>Jessica
>
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