Refinements in pulsed wave and color flow Doppler in conjunction with gray scale ultrasound have made duplex ultrasonography the optimal diagnostic modality for assessment of lower extremity venous reflux. This safe, non-invasive, and cost-effective modality can accurately determine reflux in the deep, perforating and superficial venous systems of the lower extremity. However, proper technique and uniform testing using duplex ultrasonography and rapid cuff deflation are essential. In this article, the authors provide an overview of the technical and interpretive aspects of duplex ultrasound imaging for reflux in the veins of the lower extremity.
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