Increased incidence of abnormal reflux flow in lower extremity veins of cirrhotic patients by Doppler ultrasonography

OBJECTIVE: To determine incidence of abnormal reflux flow (ARF) in legs of cirrhotic patients by Doppler ultrasonography (DUS).

METHODS: We prospectively studied 100 patients and 56 controls from the Faculty of Medicine, Eskisehir Osmangazi University Eskisehir, Turkey, between January 2010 and December 2011. We classified the legs according to the Clinical Etiology Anatomy Pathophysiology (CEAP) scores. Lower extremity superficial and deep veins were examined in supine position by DUS for ARF. Reflux flows more than 1000 msec were considered as abnormal. Abnormal reflux flow was classified in 3 categories as superficial (SARF), deep (DARF), and SARF and/or DARF (ARF). We also performed abdominal DUS to depict anterior abdominal collateral and paraumbilical vein. Statistical analysis was carried out by using analysis of variance with Tukey test, t-test, and correlation coefficient analysis.

RESULTS: Percentages of SARF in patients were 56%, DARF 52%, and ARF 58%. Correlation analysis showed association between SARF or DARF or ARF and cirrhosis (p=0.002, p=0.000, p=0.001). Patients were distributed within CEAP 1 to CEAP 4. There was an association between SARF or DARF and CEAP 1 (p=0.007, p=0.000) or CEAP 2 (p=0.004, p=0.041) or CEAP 4 (p=0.022, p=0.90). We showed no correlation between CEAP 3 and SARF or DARF. There were also correlation between paraumbilical vein and SARF (p=0.015).

CONCLUSION: Cirrhotic patients increased incidence of ARF at lower extremity veins and CEAP classification creates and provides essential information.