Surgery of the short saphenous vein is associated with a high recurrence rate because of variations in the anatomy or inadequate clinical examination. To prevent this, accurate definition of the pattern and level of termination of the saphenopopliteal junction and flush ligation is necessary. Clinical examination, Doppler ultrasound, duplex scanning and peroperative venography have been compared to assess the level of termination of the short saphenous vein. In all, 64 limbs of 46 patients were examined. In 39 limbs there was primary short saphenous incompetence, in 13 limbs there was recurrent short saphenous incompetence; in ten of these there was incompetence of the gastrocnemius vein. In 12 limbs a duplex scan did not demonstrate incompetence of the short saphenous vein or gastrocnemius vein. The accuracy of these methods when locating incompetence of the short saphenous vein to within 2 cm of the saphenopopliteal junction was 56 per cent for clinical examination, 64 per cent for Doppler ultrasound and 96 per cent for duplex scanning. When there was no saphenopopliteal junction (9 per cent), duplex scanning correctly detected the pattern of the incompetent vein. The apparent success of clinical examination was because the vein was not felt above the femoral intercondylar groove and 52 per cent of the veins terminated at this level. Duplex scanning is a non-invasive technique which is almost as accurate as venography and provides additional haemodynamic information about the incompetent veins by demonstrating the presence and extent of reflux.

Venous reflux in milliliters per second has been measured in individual veins with duplex scanning. Forty-six patients (47 legs) with symptomatic varicose veins have been studied while they were in the erect position. Nineteen legs had skin changes whereas the rest (28 legs) had only varicose veins with no skin changes. In 45 limbs, reflux was confined to one vein only: long saphenous vein in 28, short saphenous vein in nine, and femoropopliteal vein in eight. In one limb, reflux was found in the long saphenous, short saphenous, and femoropopliteal veins, and in another it was found in the long and short saphenous veins. In the latter two limbs the amount of reflux found in each vein was added to obtain the total reflux in the limb. In the limbs with skin changes, reflux (median +/- 90% tolerance levels) was 30 (10 to 53) ml/sec; whereas in limbs with no skin changes it was 10 (3 to 44) ml/sec. Reflux greater than 10 ml/sec was associated with a high incidence of skin changes (66%) irrespective of whether this was in the superficial or deep veins; reflux less than 10 ml/sec was not associated with skin changes.

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Objective: To demonstrate a significant correlation between the Doppler waveform and blood flow volume in the assessment of valve efficiency. In particular the objective was to ratify use of the ‘area index’ of the wave form. Design: Pearson's correlation and zero line assessment were used. Using a phantom, multiple tests were performed so that a wide spectrum of flow volumes could be compared with corresponding Doppler waves. Setting: Private diagnostic imaging clinic with vascular surgical association. Main outcome measures: The hypothesis was that there should be a significant correlation between the Doppler wave and the blood flow volume and, in particular, the Doppler area. Results: The Doppler wave index EId demonstrated the highest correlation coefficient ( r = 0.97, p<0.01) when compared with the volume index EIV. Conclusion: While there is a strong correlation between EId and flow volume, additional study is needed to determine its place in the clinical setting.