Volume 50, Issue 2 Spring 2026 JVU 503-dd | Characteristics of Superficial Epigastric Flow Reversal in Vascular Laboratory Venous Duplex Patients-Characteristics of Superficial Epigastric Flow Reversal in Vascular Laboratory Venous Duplex Patients

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

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This retrospective study examined whether reversed flow in the superficial epigastric vein (SEV)—flow directed upward into the pelvis rather than toward the saphenofemoral junction—could indicate iliocaval venous obstruction (VO) in patients evaluated for deep vein thrombosis (DVT).<br /><br />Researchers reviewed lower-extremity venous duplex examinations performed from March 2021 to November 2025 and identified 61 patients with SEV flow reversal, involving 105 extremities. The cohort was predominantly female, with a mean age of 65. DVT was present in 67 extremities; chronic thrombus was more common than acute thrombus. Flow reversal occurred more often on the left, where prior DVT and iliocaval thrombosis were also more prevalent.<br /><br />Sixteen extremities had confirmatory interventional imaging within 90 days of the ultrasound, and all showed iliocaval obstruction. Another 15 extremities imaged outside that period were also positive. No false-positive SEV flow reversals were found among extremities with confirmatory imaging.<br /><br />The authors conclude that SEV flow reversal is a markedly abnormal finding strongly associated with iliac or caval disease. Because flow direction is a straightforward observation, routine SEV assessment could complement standard DVT ultrasound and help flag proximal obstruction. The study’s retrospective design and limited availability of confirmatory imaging mean that sensitivity, specificity, and negative predictive value could not be established. Prospective studies with systematic imaging confirmation are needed.

Keywords

superficial epigastric vein

SEV flow reversal

iliocaval venous obstruction

deep vein thrombosis

venous duplex ultrasound

iliac vein obstruction

caval thrombosis

chronic thrombus

proximal venous disease

lower-extremity venous imaging