DOI: 10.1177/15443167261474877 ISSN: 1544-3167

Characteristics of Superficial Epigastric Flow Reversal in Vascular Laboratory Venous Duplex Patients

Dana Mazarek, Abraham Ettaher, Robert P. Scissons, Mohamed Osman
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Introduction:

Superficial epigastric vein (SEV) flow reversal has been described as an indirect duplex ultrasound marker of iliocaval venous obstruction (VO), but data describing its clinical characteristics and diagnostic implications in routine vascular laboratory practice are limited. This study evaluated the demographic, anatomic, and imaging features of venous duplex patients demonstrating SEV flow reversal during evaluation for deep vein thrombosis (DVT).

Methods:

A retrospective review of lower extremity venous DVT duplex examinations was conducted between March 2021 and November 2025. Patients demonstrating abnormal SEV flow reversal were identified using the vascular laboratory reporting system and electronic medical records. Demographics, VO risk factors, DVT chronicity and distribution, laterality, and the presence of abdominal or pelvic pathology were recorded. Interventional radiographic (IR) imaging performed within 90 days of the duplex examination served as confirmatory evidence of VO.

Results:

Sixty-one patients (105 extremities) demonstrated SEV flow reversal. The cohort was predominantly female (74%, P  < .001), with a mean age of 65 years (range, 16-89). Prior DVT was more common in the left lower extremity ( P  = .005). Current DVT was present in 67 extremities, with chronic thrombus significantly more prevalent than acute thrombus ( P  < .001). Superficial epigastric vein flow reversal occurred more frequently in the left lower extremity ( P  = .003) and was most associated with left iliac or iliocaval DVT. All 16 extremities with IR correlation demonstrated iliocaval VO.

Conclusion:

Superficial epigastric vein flow reversal is a markedly abnormal duplex finding that demonstrates a strong association with iliocaval VO. In patients undergoing evaluation for DVT, routine assessment of SEV flow direction may offer a rapid, reproducible adjunct to standard venous duplex protocols and help improve detection of clinically significant iliocaval disease.

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