Correlation of Pre-Procedure Deep Venous Reflux with Need for Repeat Intervention in Venous Insufficiency: A Retrospective Review

Purpose: Symptomatic venous insufficiency is frequently associated with superficial and deep venous reflux (DVR). While superficial ablation is a mainstay of treatment, recurrent symptoms requiring repeat intervention remain common. The association between pre-procedure DVR and the need for repeat intervention is not fully characterized. The purpose of this study is to evaluate that relationship.

Materials and Methods: We performed a single-center retrospective review of 197 patients (n = 198 limbs) who underwent endovenous intervention between 2023 and 2025. Patients were included if pre-procedure duplex ultrasound data were available, including reflux time (seconds) and vein diameter (cm) for common femoral, femoral, popliteal, and saphenofemoral junction segments. Post-procedure duplex data were collected when available. Patients were stratified by DVR duration categories (< 1 s, 1–2 s, ≥ 2 s) and compared between initial interventions (n = 177, 89%) and initial interventions that resulted in repeat interventions (n = 20, 11%). Chi-square tests were used to assess associations between DVR duration and repeat intervention.

Results: Pre-procedure DVR was most common in the common femoral vein (CFV) and femoral vein (FV), with 76 limbs demonstrating > 1 s reflux and 42 limbs demonstrating ≥ 2 s reflux in each segment. Popliteal reflux was less frequent, present in 19 limbs with > 1 s reflux and 12 limbs with ≥ 2 s reflux. When comparing patients with and without repeat interventions, analysis demonstrated a statistically significant association between reflux duration and need for repeat intervention for both 1–2 s reflux (χ² = 4.10, p = 0.043) and ≥ 2 s reflux (χ² = 4.13, p = 0.042), whereas < 1 s reflux showed no association (χ² = 0.00, p = 0.995).

Conclusion: In this cohort, DVR reflux ≥ 1 second was significantly associated with the need for repeat intervention. These findings suggest that even moderate reflux (1–2 s) in the deep venous system may be clinically relevant for recurrence risk and should be considered in patient selection and counseling.