A comparison of two sapheno-femoral junctions in one patient

The above is the abnormal Rt side. 

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• In sapheno-femoral incompetence, the color Doppler ultrasound will show retrograde (backward) flow in the saphenous vein when the patient is standing.
• The retrograde flow is typically seen at the sapheno-femoral junction, where the saphenous vein empties into the deep femoral vein.
• This retrograde flow may be continuous or intermittent, depending on the severity of the incompetence.

Spectral Doppler Ultrasound Findings:

• Spectral Doppler ultrasound is used to measure the velocity and direction of blood flow in the veins.
• In sapheno-femoral incompetence, spectral Doppler ultrasound will show a reversal of flow in the saphenous vein when the patient is standing.
• The velocity of the retrograde flow is typically higher than the normal flow in the vein when the patient is supine.
• This increased velocity can be quantified and used to grade the severity of the incompetence.
• In the above right side: there's severe incompetence with a flow reversal of more than 4 seconds. 

What are the grades of reflux in SFJ?

Grading of reflux based on the duration of reflux in sapheno-femoral or venous incompetence using Doppler ultrasound:

• Grade 0: No reflux detected.
• Grade 1: Reflux lasting less than 0.5 seconds.
• Grade 2: Reflux lasting between 0.5 and 1.0 seconds.
• Grade 3: Reflux lasting longer than 1.0 seconds or continuous reflux.

In addition to the duration of reflux, other factors such as the location and extent of the reflux are also taken into account when grading venous incompetence

Let's have a look at the normal left SFJ:

The difference in the left side is obvious. No reversed flow, on color Doppler or spectral Doppler ultrasound. 

General information:

Sapheno-femoral incompetence refers to the inability of the saphenous vein to properly empty into the femoral vein. Color Doppler ultrasound is a diagnostic tool used to detect this condition. In a normal junction, blood flows unidirectionally, but in incompetent junctions, blood flow is reversed, causing reflux. Venous insufficiency, varicose veins, and chronic venous disease are common complications of this condition. Endovenous ablation and sclerotherapy are effective treatments for sapheno-femoral incompetence, and early intervention can prevent further complications.