Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs – UIP Consensus Document. Part I: Basic principles

Abstract

Objectives: Duplex ultrasound investigation has become the reference standard in assessing the morphology and haemodynamics of the lower limb veins. The project described in this paper was an initiative of the Union Internationale de Phlébologie (UIP). The aim was to obtain a consensus of international experts on the methodology to be used for assessment of veins in the lower limb by ultrasound imaging. Design: Consensus conference leading to a consensus document. Methods: The authors invited a group of experts from a wide range of countries to participate in this project. Electronic submissions from the experts were made available to all participants via the UIP website. The authors prepared a draft document for discussion at a UIP Chapter meeting held in San Diego, USA, in August 2003. Following this meeting, a revised manuscript was circulated to all participants, and further comments were received by the authors and included in subsequent versions of the manuscript. Eventually, all participants agreed on a final version of the paper. Results: The experts have made detailed recommendations concerning the methods to be used for duplex ultrasound examination, as well as the interpretation of images and measurements obtained. This document suggests a methodology for complete assessment of the superficial and perforating veins of the lower limbs, including recommendations on reporting results and training of personnel involved in these investigations. Conclusions: The authors and a large group of experts have agreed a methodology for the investigation of the lower limbs venous system by duplex ultrasonography.

Clinical and duplex ultrasound evaluation of lower extremities varicose veins – a practical guideline

“…In the past years, an international agreement on the LEVV anatomic terminology and duplex anatomy was reached [5][6][7][8]. This section describes this anatomy, focusing on sonographic criteria.…”

“…The additional assessment of the perivascular structures is also helpful to distinguish further diff erential diagnoses. In recent years, many attempts have been made to standardize the duplex ultrasound of the veins of the lower limbs before and after treatment [6,7,[38][39][40]. The following section describes this standardized duplex ultrasound examination.…”

“…For other superfi cial and deep veins of the lower limb, a cut-off value of 500 ms is recommended [16] (Figure 5b). For perforating veins, cut-off values of both 350 ms and 500 ms have been proposed in the literature [6,42]. Furthermore, beside refl ux time, a perforating vein diameter of more than 3.5 mm at the point where it passes through the muscle fascia ( Figure 4c) has been evaluated as surrogate marker to defi ne incompetence [43].…”

“…In fact, detection of a retrograde fl ow in the common femoral vein/popliteal vein just proximally to the SFJ/SPJ could also be present in case of a refl ux of the GSV/SSV with involvement of the SFJ/SPJ. An examination of the deep veins of the calf for refl ux and thrombosis is recommended in specifi c clinical cases (e. g. prior deep vein thrombosis, venous ulcer or a pathological perforator vein on the calf) [6].…”

“…The written report should also include the reason for undertaking the investigation and important fi ndings (presence and extent of refl ux, patency, morphology, and diameters of the veins at critical points, such as 3 cm below the SFJ, at mid-thigh level, at the knee and at mid-calf level for the GSV and 3 cm below the SPJ and mid-calf for the SSV [38]). Furthermore, a sketch can help to illustrate these fi ndings [6] and often provides an excellent overview especially in patients with more complex LEVV.…”