Relationship between incompetent perforator veins and pigmentation below the knee in patients with chronic venous disease.

OBJECTIVE

The aim of the present study was to evaluate the correlation between incompetent perforator veins (PVs) and venous pigmentation.

METHODS

A total of 203 limbs of patients with chronic venous disease were studied. The limbs were classified into two groups: C2 group (varicose veins) and C4a group (skin changes with pigmentation). The PVs of the lower legs were examined using Doppler ultrasound. The diameter, reflux duration, and peak velocities were measured and analyzed. The pigmentation area in the lower leg was also studied.

RESULTS

Pigmentation in the lower legs was significantly associated with venous insufficiency of the PVs. The prevalence of PVs insufficiency was higher for the C4a patients compared with the C2 patients (96 of 164 [58.3%] vs 4 of 39 [10.3%]; P < .001). The presence of incompetent PVs was associated with an increased risk of pigmentation (OR, 8.977; 95% CI, 2.824-28.537; P < .001). The higher the patients' pigmentation severity (higher VCSS), the greater the prevalence of perforator venous insufficiency (P < .001). The PVs in the areas of pigmentation were larger in diameter, required longer to reach peak velocity, and had higher peak velocities than the PVs in nonpigmented limbs (P < .01 for all). We found a linear relationship between the pigmentation area and the diameter of the PV, reflux time, and peak velocity (r = 0.272, r = 0.172, and r = 0.664, respectively; P < .05).

CONCLUSIONS

Incompetent PVs are a significant risk factor for venous pigmentation and, therefore, are potentially suitable for surgical correction.