What is Superficial Venous Reflux and why is it a problem?

The venous system is best thought of as two parallel systems, the deep system of veins and the superficial system of veins. These venous systems are connected by hundreds of perforating vessels (each equipped with one way valves) as well as by two larger veins, the Greater Saphenous Vein and the Lesser Saphenous Vein.

The Deep system is responsible for the return of 90-95% of the blood back to the heart.  The Superficial system acts as a reservoir of blood, storing blood until it can pass through a perforating vein into the deep system to be returned to the heart. Only 5-10% of blood returned to the heart is via the superficial system.

The deep system of veins lies beneath the muscles and the fascia of the muscles and is under relatively high pressure. The superficial system lies directly underneath the skin and is under low pressure and is separated from the deep system by one-way valves.  Failure of these one-way valves lead to abnormal pressures within the superficial system and decreases blood return to the heart via the “muscular pump” of the deep system due to abnormal flow of blood to the low-pressure superficial system.

The deep veins use a muscular "pump" to return the blood uphill against gravity. This pump relies on the proper function
of valves spaced along the course of the deep veins as well as those that protect the superficial veins from the high venous pressure in the deep system.

The superficial system experiences increased blood volume with increased pressure.  Dilation of the superficial system
occurs (varicose vessels).  As adjacent valves are pulled further apart and begin to leak, the varicose vessel extends in size and length
and can often be seen to “branch”.  Superficial venous hypertension can result, leading to pain and the
more serious complications of venous insufficiency including non healing ulcerations, edema and skin changes.

The image on the left shows normal function of the venous system.  The image on the right shows abnormal reflux of blood from the deep system (Common Femoral Vein or CFV) to the superficial system (Greater saphenous vein or GSV).

Severe and prolonged reflux can lead to chronic skin changes-
Skin "Hardening"
Skin breakdown

Skin ulcers
Ultrasound can demonstrate the connections (and, at times, abnormal connections) between the deep and superficial system.  Using the ultrasound, a map demonstrating the function of the veins in the leg can be determined and the best treatment options can be determined.  A vein specialist will then be able to discuss the various options for treatment, the expected results and any risks that may be associated with treatment.  It is important to keep in mind that failure to treat abnormal venous reflux carries risk as well, something that you should discuss with your vein specialist.

An ultrasound image demonstrating a vein connecting the deep system (under the muscle) to the superficial system (at the top the screen).