Clinical and ultrasonographic predictors of incompetent perforating veins in patients undergoing endovenous treatment for varicose veins

Objectives Incompetent perforating veins (IPVs) are important contributors to chronic venous disease (CVD), yet their clinical significance remains incompletely understood. This study aimed to evaluate the clinical and ultrasonographic characteristics associated with IPVs in patients undergoing endovenous treatment for varicose veins. Methods A retrospective analysis was conducted on 192 limbs treated between 2021 and 2025. Limbs were categorized into IPV-positive and IPV-negative groups based on duplex ultrasonography. Clinical severity was assessed using the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. Multivariable logistic regression and receiver operating characteristic (ROC) analysis were performed to identify predictors of IPV presence. Results Among 192 limbs, IPVs were identified in 102 (53.1%). Multivariable analysis identified saphenofemoral junction (SFJ) diameter as an independent predictor of IPV (Odds Ratio [OR]: 1.26; 95% CI: 1.08–1.49; p = 0.005). ROC analysis revealed an optimal cutoff for SFJ diameter of 7.75 mm for predicting IPV (Area Under the Curve [AUC]: 0.646; sensitivity 65.0%, specificity 65.2%). CEAP classification was numerically higher in the IPV-positive group (3.11 vs 2.86), although the difference was not statistically significant ( p = 0.379). Conclusion SFJ diameter was independently associated with IPV presence and may serve as a practical ultrasonographic marker for identifying perforator incompetence in patients with varicose veins. Standardized duplex ultrasonography, including assessment of SFJ diameter, may facilitate objective treatment planning.