Ultrasound is a diagnostic tool of choice for venous disease. As treatment is based on ultrasound results, accurate examination is essential and image optimization is necessary to provide objective information. Understanding the physical properties and knobology of ultrasound helps to obtain good images. To begin with, comfortable placement of the ultrasound for the examiner to use and the appropriate positioning of the patient is also important. The next step for an optimal ultrasound image is to attain good resolution to a given depth. It is also essential to appropriately utilize the provocation maneuvers when diagnosing a suspected disease, especially for the chronic venous disease.

In the diagnosis of varicose veins, duplex ultrasound scanning is recommended as the diagnostic test of choice. Both superficial and deep veins must be tested accurately and consistently in a standardized manner. Ultrasonography, while effective, is highly dependent on the examiner and requires standardization. To ensure reliable results, it is crucial to obtain high-quality images of superficial veins using a high-frequency linear array transducer during ultrasound examinations of the lower extremities. Image optimization techniques should be employed to minimize artificial images and enhance diagnostic quality. When conducting ultrasound examinations of the lower extremities, specifically for varicose veins, performing the venous reflux test in a standing position is essential. This positioning allows for testing under conditions more similar to physiological ones, ensuring a more accurate assessment of pathological reflux influence.

Non-thermal, non-tumescent (NTNT) techniques for varicose vein treatment have gained significant attention as alternatives to traditional thermal ablation methods, providing less invasive options with fewer complications and less downtime. This review examines the efficacy, safety, and patient outcomes associated with NTNT modalities such as cyanoacrylate adhesive closure, mechanochemical ablation (MOCA), and polidocanol endovenous microfoam (PEM). Recent trials suggest these NTNT methods achieve closure rates comparable to thermal methods, with lower complication rates and improved patient satisfaction. Key metrics from recent studies, including technical success, recurrence rates, and complication profiles, underscore the promise of NTNT techniques as first-line therapies. Findings also indicate variability in recurrence rates and complication profiles depending on vein anatomy and patient characteristics. In conclusion, NTNT approaches represent a promising evolution in varicose vein treatment, warranting further studies to standardize outcomes and optimize patient selection.

In the treatment of varicose veins, accurate diagnosis through ultrasound examination is very important. Recently, major academic societies have previously reported guidelines for ultrasound examination of varicose veins and have been continuously revising and publishing them. Referring to these major reports, domestic academic societies in the Republic of Korea related to the treatment of varicose veins have also published guidelines for ultrasound examination of lower extremity insufficiency and varicose veins. In addition, various related academic societies and institutions in the United States and Europe have made detailed recommendations on the technical aspects of ultrasound examination of lower extremity venous insufficiency and varicose veins. Medical technician associations related to ultrasound examination have also established their own guidelines for examination methods, etc. If an accurate diagnosis is made based on these guidelines, better treatment results for lower extremity varicose veins can be expected.