The diagnosis and treatment of chronic venous disease has undergone a quantum leap forward in recent decades. In many ways, the venous system is now considered more complex than the arterial system. This is a result of the advances in understanding due to improvements in duplex ultrasound equipment, diagnostic techniques, and communication standards as they relate to findings in anatomy, pathology, and hemodynamics. Currently, it is self-evident that duplex ultrasound has become the gold standard for diagnosis of the venous system providing anatomic and functional information. Mapping techniques, understanding of superficial reflux, and other factors that affect duplex ultrasound findings are presented. These factors and techniques can affect diagnostic results and therefore have significant impact on the planning and approach to treatment of primary and recurrent venous insufficiency.
Talbot S., Oliver M.Techniques of Venous Imaging. 2nd ed. Pasadena, CA: Davies; 1992.
4.
Meissner MH, Moneta G., Burnand K., et al. The hemodynamics and diagnosis of venous disease. J Vasc Surg. 2007;46(suppl):4S-24S.
5.
Labropoulos N., Leon M., Nicolaides AN, Giannoukas AD, Volteas N., Chan P.Superficial venous insufficiency: correlation of anatomic extent of reflux with clinical symptoms and signs. J Vasc Surg. 2004;40:953-958.
6.
Rollins A., Rosa C.Surgical management of chronic venous disease. J Vasc Technol . 2002;26:219-225.
7.
Semrow CS, Laborde A., Buchbinder D., Rollins DLPreoperative mapping of varicosities and perforating veins: a preliminary report. J Vasc Technol. 1990;14:72-74.
Fischer R., Chandler J., Stenger D., Puhan M., De Maeseneer M., Lutz Schimmelpfennig L.Patient characteristics and physician-determined variables affecting saphenofemoral reflux recurrence after ligation and stripping of the great saphenous vein . J Vasc Surg. 2006;43:81-87.
10.
Tarrant G., Clarke J.Differences in venous function of the lower limb by time of day: a comparison of chronic venous insufficiency between an afternoon and a morning appointment by duplex ultrasound. J Vasc Ultrasound. 2008 ;32:187-192.
11.
Knight R., Zygmunt J.In: Proceedings of the Phlebology Society of America: Echosclerotherapy . Kansas City, KS: Phlebology Society of America; 1988:37-39.
12.
Knight R., Vin F., Zygmunt J. In: Proceedings of the 10th Congress of the International Union of Phlebologie: Ultrasonic Guidance of Injections Into the Superficial Venous System, Strausbourg, France; 1989:339-341.
13.
Knight R., Zygmunt J. In: Proceedings of the 10th Congress of the International Union of Phlebologie: Ultrasonic Detection of the Efficacy of Injection Sclerotherapy of the Sapheno-Femoral Junction, Strausbourg, France; 1989: 800-801.
14.
Carandina S. , Mari C., DePalma M., et al. Varicose vein stripping vs haemodynamic correction (CHIVA): a long term randomized trial . Eur J Vasc Endovasc Surg. 2008; 35:230-237.
15.
Kabnick LSNew horizons in the treatment of saphenous vein reflux. J Vasc Technol. 2002;26:239-246.
16.
Min R., Zimmet S., Issacs M., Forrestal M.Endovenous laser treatment of the incompetent greater saphenous vein . J Vasc Interv Radiol. 2002;12:1167-1171.
17.
Merchant RF , DePalma RG, Kabnick LSEndovascular obliteration of saphenous reflux: a multicenter study. J Vasc Surg. 2002;35:729-736.
18.
Morrison N. , Neuhardt D.Comparative study of radiofrequency vs laser ablation of the greater saphenous vein: one year follow-up. Paper presented at: 16th Annual Congress of the American College of Phlebology, November 2002.
19.
Blomgren L. , Johansson G., Dahlberg-Åkerman , Thermaenius P, Bergqvist D.Changes in superficial and perforating vein reflux after varicose vein surgery. J Vasc Surg. 2005;42:315-320.
20.
Lurie F., Kistner R., Eklof B., Kessler D., Mechanism of venous valve closure and role of the valve in circulation: a new concept. J Vasc Surg. 2003;38:955-961.
21.
Rodriguez A. , Whitehead M., McLaughlin R., Umphrey S., Welch H., O’Donnell T.Duplex-derived valve closure times fail to correlate with reflux flow volumes in patients with chronic venous insufficiency. J Vasc Surg. 1996;23:606-610.
22.
Pemble L.Lower extremity venous cross-sectional area changes associated with pregnancy . J Vasc Ultrasound. 2006;30:75-80.
23.
Coleridge-Smith P., Labropoulos N., Partsch H., Myers K., Nocolaides A., Cavezzi A.Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs: UIP consensus document. Part I: Basic principles. Eur J Vasc Endovasc Surg. 2006;31:83-92.
24.
Cavezzi A., Labropoulos N., Partsch H., et al. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs: UIP consensus document. Part II: Anatomy. Eur J Vasc Endovasc Surg. 2006;31: 288-299.
25.
Caggiatti A. , Bergan JJThe saphenous vein: derivation of its name and relevant anatomy. J Vasc Surg. 2002;35: 172-175.
26.
Pieri A., Gatti M., Santini M., Marcelli F., Carnemolla A.Ultrasonographic anatomy of the deep veins of the lower extremity . J Vasc Technol. 2002;26:201-211.
27.
Caggiati, A. , Bergan JJ, Gloviczki P., Eklof B., Allegra C., Partsch H.Nomenclature of the veins of the lower limb: extensions, refinements, and clinical application . J Vasc Surg. 2005;41:719-724.
28.
Caggiati A. , Ricci S.The long saphenous vein compartment. Phlebology. 1997;12:107-111.
29.
Chiesa R., Marone EM, Limoni C., Volontè M., Petrini O.Chronic venous disorders: correlation between visible signs, symptoms, and presence of functional disease. J Vasc Surg. 2007;46:322-330.
30.
Labropoulos N. , Delis K., Nicolaides AN, Leon M., Ramaswami G., Volteas N.The role of the distribution and anatomic extent of reflux in the development of signs and symptoms in chronic venous insufficiency. J Vasc Surg . 1996;23:504-510.
31.
Labropoulos N. , Leon L., Kwon S.Study of the venous reflux progression. J Vasc Surg. 2005;41:291-295.
32.
Labropoulos N. , Tiongson J., Pryor L., et al. Definition of venous reflux in lower-extremity veins. J Vasc Surg. 2003;38:793-798.
33.
Jutley R., Cadle I., Cross K.Preoperative assessment of primary varicose veins: a duplex study of venous incompetence. Eur J Vasc Endovasc Surg. 2001 ;21: 370-373.
34.
Foldes M., Blackburn M., Hogan J., et al. Standing versus supine positioning in venous reflux evaluation . J Vasc Technol. 1991;15:321-324.
35.
Maurins U., Hoffmann B., Lösch C., Jöckel KH, Rabe E., Pannier F.Distribution and prevalence of reflux in the superficial and deep venous system in the general population: results from the Bonn Vein Study, Germany. J Vasc Surg. 2008;48:680-687.
36.
Stuart W., Lee A., Allan P., Ruckley V., Bradbury A.Most incompetent calf perforating veins are found in association with superficial venous reflux. J Vasc Surg. 2001 ; 43:774-778.
37.
van Bemmelen P., Bedford G., Beach K., Strandness DEQuantitative segmental evaluation of venous valvular reflux with duplex ultrasound scanning . J Vasc Surg . 1989;10:425-431.
38.
Labropoulos N., Tassiopoulos A., Bhatti A., Leon L.Development of reflux in the perforator veins in limbs with primary venous disease. J Vasc Surg. 2006;43: 558-562.
39.
Beckwith T. , Richardson G., Sheldon M., Clarke G.A correlation between blood flow volume and ultrasonic Doppler wave forms in the study of valve efficiency. Phlebology. 1993;8:12-16.
40.
Partsch B., Partsch H.Calf compression pressure required to achieve venous closure from supine to standing positions. J Vasc Surg. 2005;42:734-738.
41.
Zamboni P., Cisno C., Marchetti F., Quaglio D., Mazza P., Liboni A.Reflux elimination without any ablation or disconnection of the saphenous vein. A haemodynamic model for venous surgery. Eur J Vasc Endovasc Surg. 2001;21:361-369.
42.
Kostas T., Ioannou C., Touloupakis E., et al. Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. Eur J Vasc Endovasc Surg. 2004;27:275-282.
43.
Creton, D., Pare ECDiameter reduction of the proximal long saphenous vein after ablation of a distal incompetent tributary. Dermatol Surg. 1999;25:394-398.
44.
Somjen GM, Royle JP, Fell G., Roberts AK, Hoare MC, Tong Y.Venous reflux patterns in the popliteal fossa. J Cardiovasc Surg. 1992;33:85-91.
45.
Francheschi C.Theorie et Pratique de la Cure Conservatrice et Hemodynamique de l’Insuffisance Veineuse en Ambulatiore. Precy-sous-Thil, France: Editions de l’Armancon ; 1988.
46.
Wong JKF , Duncan JL, Nichols DMWhole-leg duplex mapping for varicose veins: observations on patterns of reflux in recurrent and primary legs, with clinical correlations. Eur J Vasc Endovasc Surg. 2003;25:267-275.
47.
Society of Vascular Ultrasound.Vascular Technology Professional Performance Guidelines. Lower Extremity Venous Insufficiency Evaluation. http://www.svunet.org/positions/LEVenousInsufficiencyEvaluation.pdf . Accessed May 8, 2009.
48.
Society of Vascular Ultrasound.Vascular Technology Professional Performance Guidelines. Lower Extremity Arterial Duplex Evaluation. http://www.svunet.org/positions/LEArterialDuplexEvaluation.pdf. Accessed May 9, 2009.
49.
Francheschi C. , Zamboni P.Paper presented at: Venous Hemodymanics Conference , Part I, Pheonix AZ, February 2009.
50.
Hannon K., Iafrati M., Mackey W.Complex lower-extremity venous disease. J Vasc Ultrasound . 2006;30: 167-169.
51.
Parks T., Lamka C., Nordestgaard A.Changes in perforating vein reflux after saphenous vein ablation. J Vasc Ultrasound. 2008;32:141-144.
