The Impact of Duplex Scanning in Phlebology

Abstract

Chronic venous disease (CVD) is a tremendous medical and economic burden on society. In the past two decades the use of duplex ultrasound has emerged as the diagnostic method of choice for the diagnosis and management of CVD. In this article, we describe the specific techniques used in the assessment of the superficial, perforating, and deep venous systems. We also discuss the methods of ulcer bed and chronic obstruction evaluation. The contributions of the duplex ultrasound to the understanding of the pathophysiology and improvement of treatments for chronic venous disease are reviewed.

Technical Feasibility and Early Results of Radiologic-Guided Foam Sclerotherapy for Treatment of Varicose Veins

“…In the United States and Europe, ultrasound (US) has been the primary modality for evaluating varicose veins for longer than two decades 1,2 . US is popular in these regions because it has few risks and is noninvasive, accessible in most settings, cost effective, and acceptable to most patients.…”

“…Although not necessary for reticular veins, 4 preoperative duplex US can show the presence and anatomic extent of venous reflux at the saphenofemoral and saphenopopliteal junctions, common femoral vein, popliteal vein, and superficial veins 5 . It can also predict obstruction of the femoralpopliteal or iliofemoral segments in 80% to 90% of patients 6 and is useful in assessing chronic venous obstruction in all classes of chronic venous disease 1 . In addition to its rapid access and accuracy, US allows preoperative marking of target veins directly on the patient's skin 7 .…”

“…In addition to its rapid access and accuracy, US allows preoperative marking of target veins directly on the patient's skin 7 . However, US cannot be used to accurately determine the flow or duration of reflux; standard compression pressure should be used for this assessment 1 . In addition, it may be unreliable in defining incompetent perforating veins in patients with CEAP classification C4‐6, 6 perforator disease in the thigh or medial calf, 8 greater saphenous vein insufficiency, 9 or complex or unusual causes of varicose veins 9 .…”

“…I n the United States and Europe, ultrasound (US) has been the primary modality for evaluating varicose veins for longer than two decades. 1,2 US is popular in these regions because it has few risks and is noninvasive, accessible in most settings, cost effective, and acceptable to most patients. At the Second European Consensus Meeting on Foam Sclerotherapy, duplex US guidance was identified as mandatory during puncture and injection of nonvisible varicose veins because it aids in confirming needle placement, visualizing foam injection and distribution, and evaluating therapeutic outcomes.…”

“…5 It can also predict obstruction of the femoralpopliteal or iliofemoral segments in 80% to 90% of patients 6 and is useful in assessing chronic venous obstruction in all classes of chronic venous disease. 1 In addition to its rapid access and accuracy, US allows preoperative marking of target veins directly on the patient's skin. 7 However, US cannot be used to accurately determine the flow or duration of reflux; standard compression pressure should be used for this assessment.…”