Ann Phlebology 2022; 20(2): 49-51
Published online December 31, 2022
https://doi.org/10.37923/phle.2022.20.2.49
© Annals of phlebology
Correspondence to : Hyangkyoung Kim, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea, Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine
Tel: 02-440-6261, Fax: 02-440-6296
E-mail: cindycrow7456@gmail.com
Venous incompetence of the lower extremity is a common clinical problem. Duplex ultrasonography is the method of choice to evaluate patients with chronic venous disease as it provides the distribution and extent of reflux, anatomic variations, vein diameter, tortuosity, distance from the skin, luminal obstruction (acute thrombosis and chronic post-thrombotic changes) thus being able to determine the modality and extent of treatment (
Examples of duplex ultrasonography image and reporting sheet are shown in Fig. 1 and 2. When documenting reflux, examiners should include following information to provide reliable results; the name of the vein segment where the reflux was observed, the reflux time, and the flow direction. First, it is essential to record the name of the vein for which reflux was measured to provide a clear rationale for indications for treatment and for communication with other physicians. Depending on the protocol used for each center, the common femoral vein, proximal to the sapheno-femoral junction, the sapheno-femoral junction, the great saphenous vein from groin to ankle, the femoral vein, the popliteal vein and the small saphenous vein from junction to ankle and its thigh extension as well as perforating veins are interrogated with duplex imaging. When the physical examination suggests non-saphenous origin reflux, popliteal fossa vein, sciatic nerve vein or tibial vein can also be examined. Second, reflux time should be recorded. Retro-grade flow in the lower-extremity veins occurs physio-logically just before valve closure, and pathologically as a result of valve absence or incompetence (
Another thing to consider in ensuring accurate examina-tion results is patient position; in a dependent position either by having the patient lying in the reverse Trendelenburg position or in the standing position. Alternatively, for scanning below the knee, the patient may be seated with legs down. It is also recommended to have standard worksheets at each center to provide complete examination results with guaranteed quality.
As duplex ultrasound is important in patients with venous incompetence, the examiner should put forth the best efforts to present reliable test results. The establishment of guidelines reflecting the domestic situation should also be considered.
Ann Phlebology 2022; 20(2): 49-51
Published online December 31, 2022 https://doi.org/10.37923/phle.2022.20.2.49
Copyright © Annals of phlebology.
Hyangkyoung Kim, M.D., Ph.D.1, and Nicos Labropoulos, Ph.D.2
1Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea, 2Department of Surgery, Stony Brook University Medical Center, NY, USA
Correspondence to:Hyangkyoung Kim, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea, Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine
Tel: 02-440-6261, Fax: 02-440-6296
E-mail: cindycrow7456@gmail.com
Venous incompetence of the lower extremity is a common clinical problem. Duplex ultrasonography is the method of choice to evaluate patients with chronic venous disease as it provides the distribution and extent of reflux, anatomic variations, vein diameter, tortuosity, distance from the skin, luminal obstruction (acute thrombosis and chronic post-thrombotic changes) thus being able to determine the modality and extent of treatment (
Examples of duplex ultrasonography image and reporting sheet are shown in Fig. 1 and 2. When documenting reflux, examiners should include following information to provide reliable results; the name of the vein segment where the reflux was observed, the reflux time, and the flow direction. First, it is essential to record the name of the vein for which reflux was measured to provide a clear rationale for indications for treatment and for communication with other physicians. Depending on the protocol used for each center, the common femoral vein, proximal to the sapheno-femoral junction, the sapheno-femoral junction, the great saphenous vein from groin to ankle, the femoral vein, the popliteal vein and the small saphenous vein from junction to ankle and its thigh extension as well as perforating veins are interrogated with duplex imaging. When the physical examination suggests non-saphenous origin reflux, popliteal fossa vein, sciatic nerve vein or tibial vein can also be examined. Second, reflux time should be recorded. Retro-grade flow in the lower-extremity veins occurs physio-logically just before valve closure, and pathologically as a result of valve absence or incompetence (
Another thing to consider in ensuring accurate examina-tion results is patient position; in a dependent position either by having the patient lying in the reverse Trendelenburg position or in the standing position. Alternatively, for scanning below the knee, the patient may be seated with legs down. It is also recommended to have standard worksheets at each center to provide complete examination results with guaranteed quality.
As duplex ultrasound is important in patients with venous incompetence, the examiner should put forth the best efforts to present reliable test results. The establishment of guidelines reflecting the domestic situation should also be considered.