The Role of Ultrasound in the Diagnosis and Treatment of Chronic Venous Insufficiency

Abstract

Chronic venous insufficiency (CVI) is an exceedingly common and underdiagnosed disorder with a wide range of symptoms and prognosis ranging from cosmetic issues to skin ulceration with tissue loss. Ultrasound plays a pivotal role in the diagnosis, classification, and guidance of percutaneous treatment of CVI. It is therefore of critical importance to the practicing radiologist to have a sound understanding of the pathophysiology, pertinent venous anatomy, and classification of CVI. We review the superficial and deep venous anatomy of the lower extremity, introduce a pattern recognition approach for mapping of varicosities, and review the protocol for ultrasound evaluation for CVI. In addition, we discuss the pathophysiology of CVI and the role of ultrasound in guidance for and follow-up of percutaneous treatment.

The cutoff value for the diameter of the saphenous vein in predicting the presence of venous insufficiency

“…(6,7). The enlargement of the venous diameter leads to the incompetency of valves, which may be concluded as further caudal venous dilatation and valvular incompetence (8,9,10).…”

AIUM Practice Parameter for the Performance of a Peripheral Venous Ultrasound Examination

“…Anatomic variations, such as duplications, should be noted. Venous Insufficiency: Lower Extremity Technique Reflux is evaluated as documented by spectral Doppler waveforms showing the baseline and the response to accepted provocative maneuvers . An abnormal reflux time should be reported . Measurement units must be consistent and can be expressed in units of either milliseconds or seconds.…”

Endovenous laser ablation and foam sclerotherapy for varicose veins: does the presence of perforating vein insufficiency affect the treatment outcome?

“…swelling, heaviness, warmth, itching, cramping, and muscle fatigue to inflammatory dermatitis and venous stasis ulcers (2).…”