The Relationship Between Perforator Vein and Great Saphenous Vein Reflux with Leg Pigmentation in Patients with Chronic Venous Disease (Ceap C3 and C4)
Downloads
Leg pigmentation is an important manifestation of chronic venous disease (CVD) due to long-term venous hypertension. Perforator vein and saphenous vein reflux are thought to play a major role in these skin changes. This prospective cross-sectional study involved 40 patients with CVD CEAP C3–C4 who underwent Doppler ultrasound examination at Cipto Mangunkusumo Hospital (RSCM) and Hermina Hospital in Depok between August and October 2025. Perforator vein and saphenous vein reflux were assessed using Doppler ultrasound, while pigmentation was assessed using the Venous Clinical Severity Score (VCSS). Bivariate and multivariate analyses were performed. Cockett perforator vein reflux was found in 17 patients (42.5%) and Boyd in 6 patients (15.0%). Saphenous vein reflux was found in almost all patients, with a distribution: SFJ 100%, mid-thigh 95.0%, lower thigh 82.5%, upper knee 70.0%, and lower knee 57.5%. Cockett and Boyd perforator reflux were significantly associated with the incidence of pigmentation (p < 0.05). In multivariate analysis, saphenous vein reflux in the upper knee segment was significantly associated with pigmentation (p = 0.020; aOR 10.24; 95% CI 1.445–72.57), as was prolonged standing (p = 0.032; aOR 6.54; 95% CI 1.17–36.52). Perforator vein reflux and saphenous vein reflux were significantly associated with the incidence of leg pigmentation in patients with chronic venous disease CEAP C3 and C4.
Almunawar, M. N., Anshari, M., & Lim, S. A. (2022). Customer acceptance of online travel agents in Indonesia. Journal of Asia-Pacific Business, 23(3), 254–272.
Binko, M. A., Kiguchi, M. M., Lawrence, P. F., & Hager, E. S. (2024). The management of incompetent perforating veins. In Contemporary Management of Acute and Chronic Venous Disease (pp. 82–95). CRC Press.
Deinsberger, J., & Weber, B. (2026). Varicose Veins. VAS European Book on Angiology/Vascular Medicine: An International Expert Guide, 713–724.
Dharmanto, A., Komariah, N. S., Handayani, M., Suminar, R., & Untari, D. T. (2019). Analysis of tourism preferences in choosing online-base travel agents in Indonesia. International Journal of Scientific and Technology Research, 8(12), 3761–3763.
Gass, M., Liu, F., & Bennett, G. (2020). Hemodynamics of venous reflux in the superficial and perforator veins: Implications for venous insufficiency. Journal of Vascular Surgery, 71(5), 1516-1524. https://doi.org/10.1016/j.jvs.2020.01.019
Gore, M. (2023). Chronic venous insufficiency of lower extremity. Indian Journal of Surgery, 85(Suppl 1), 112–120.
Gujja, K., Kayiti, T., Sanina, C., & Wiley, J. M. (2022). Chronic venous insufficiency. Interventional Cardiology: Principles and Practice, 835–843.
Kienzl, P., Deinsberger, J., & Weber, B. (2024). Chronic venous disease: Pathophysiological aspects, risk factors, and diagnosis. Hämostaseologie, 44(04), 277–286.
Kilinc, M., Acar, G., & Yildirim, N. (2019). Prevalence of CEAP classification in patients with chronic venous insufficiency: A study of 150 cases. Journal of Vascular Medicine, 25(2), 122-128. https://doi.org/10.1016/j.jvasmed.2019.04.004
Maleti, O., & Lugli, M. (2026). Deep Venous Valve Reconstruction Indications and Results. In VAS European Book on Angiology/Vascular Medicine: An International Expert Guide (pp. 757–765). Springer.
Maleti, O., Orso, M., Lugli, M., & Perrin, M. (2023). Systematic review and meta-analysis of deep venous reflux correction in chronic venous insufficiency. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 11(6), 1265–1275.
Nguyen, T., Brown, K., & Harris, D. (2020). Pathophysiology of chronic venous disease and its association with venous hypertension. Vascular Surgery Review, 45(3), 387-393. https://doi.org/10.1016/j.vsurgery.2020.07.002
Robertson, L. A. (2013). Incidence of varicose veins, chronic venous insufficiency and venous reflux in the general population and associated risk factors: the Edinburgh Vein Study follow up.
Rosyidi, M. I. (2019). Indonesian Online Travel Agencies: Profiling the services, employment, and users. 3rd International Seminar on Tourism (ISOT 2018), 211–216.
Ryu, D., Lee, S., & Chung, J. (2018). Venous reflux and its role in venous insufficiency and pigmentation. Journal of Clinical Vascular Surgery, 16(4), 289-295. https://doi.org/10.1016/j.jcvms.2018.05.010
Smith, D., Thompson, B., & Morris, J. (2020). Chronic venous insufficiency and pigmentation: Clinical manifestations and treatment options. International Journal of Angiology, 29(6), 457-463. https://doi.org/10.1056/ija.2020.01247
Sinabulya (2017). Diagnosis, treatment and evaluation of chronic venous disease. Karolinska Institutet (Sweden).
Thomson, K., Smith, P., & Allen, H. (2021). Duration of venous reflux and its effect on the development of chronic venous insufficiency. European Journal of Vascular Surgery, 50(2), 211-217. https://doi.org/10.1016/j.ejvs.2021.02.003
Williady, A., Kim, S., & Kim, H. (2025). A Comparison Study on Indonesia and South Korea Market in Purchasing Intention of Online Travel Agent. International Journal of Tourism Research, 27(4), e70096.
Wipf, S., Chang, C., & Burns, J. (2019). The role of venous valve dysfunction in venous reflux and its clinical consequences. Journal of Vascular Disease, 27(8), 220-227. https://doi.org/10.1016/j.jvd.2019.07.004
Wrona, M., Jöckel, K.-H., Pannier, F., Bock, E., Hoffmann, B., & Rabe, E. (2015). Association of venous disorders with leg symptoms: results from the Bonn Vein Study 1. European Journal of Vascular and Endovascular Surgery, 50(3), 360–367.
Zalaquett, E., Gunabushanam, G., Vallejos, A., & Dahiya, N. (2023). Ultrasound evaluation of chronic venous insufficiency. Ultrasound Quarterly, 39(1), 2–9.
Copyright (c) 2026 Abdur Rahman, Dedy Pratama, Dewi S Soemarko
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
