Doppler Ultrasound Detection of Saphenofemoral and Saphenopopliteal Incompetence and Operative Venography to Ensure Precise Saphenopopliteal Ligation

Abstract

Recurrent varicose veins may result from inadequate assessment or inadequate surgery. In this study, 110 consecutive patients (165 limbs) were assessed pre-operatively for the presence or absence of reflux at the saphenofemoral (SF) and saphenopopliteal (SP) junctions by clinical assessment and by Doppler ultrasound. The pre-operative results where then compared with findings at the time of surgery. Doppler ultrasound as a means of predicting SF and SP incompetence was superior to clinical assessment. Doppler ultrasound detected 100% (two false positives) of incompetent SF junctions, and 100% (six false positives) of incompetent SP junctions, compared to the clinical detection of 72% (no false positives) and 64% (five false positives), respectively. Short saphenous venography was performed in 36 limbs in which SP reflux was suspected on clinical assessment and/or by Doppler ultrasound. It proved valuable in demonstrating the level and mode of termination of the short saphenous vein. This guided the placement of the skin incision.

Neovascularization in Recurrence of Varices of the Great Saphenous Vein in the Groin: Surgical Anatomy and Morphology

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Recently it has been shown that restoration of continuity of the normal femoral vein in the rat 18 and of the varicose great saphenous vein in man after transection'9-2' develops through neovascularization, not through preexisting collateral vessels. These findings confirm early observations on recurrence in 1 patient by Langenbeck22 and in 9 patients by Perthes , 23 In the present investigation the surgical anatomy and morphology of the vessels responsible for recurrence of varices of the great saphenous vein in the groin were studied in 135 patients.…”

An Anatomic Source of False Venous Reflux with Continuous Wave Doppler

“…CW Doppler test was performed by one of the authors (JR) with a 5‐MHz CW Doppler ultrasound probe (model 1052; Parks Medical Electronics Inc., Aloha, OR). Patients were tested in the standing position and the presence or absence of reflux was assessed during release of calf or thigh compression as previously described 4 …”

“…C ontinuous wave (CW) Doppler ultrasound examination has been used for years with good results in the diagnosis of saphenofemoral and saphenopopliteal incompetence in the groin and popliteal fossa 1–4 . However, several impediments have been recognized 5,6 .…”

An Evaluation of Doppler Ultrasound and Photoplethysmography in the Investigation of Venous Insufficiency

“…( 3 ) Short saphenous incompetence (SSI); (4) Long + short saphenous incompetence (LS (5) Gastrocnemius vein incompetence alone (GI); (6) Normal, no reflux detected in any of the veins + SSI); and examined.…”