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Health Protocols

Chronic Venous Disease: Varicose Veins And Venous Insufficiency


Physical Examination

The diagnosis of chronic venous disease is typically based on a detailed history and physical examination (Fort 2017a; Fort 2017b). The primary goal of the initial evaluation is to rule out serious conditions that can manifest similarly to venous disease (Fort 2017b; Fort 2017a; Wittens 2015).

Imaging Studies

Duplex ultrasonography. Duplex ultrasonography is the gold standard for evaluating the veins. Combining traditional ultrasound with Doppler ultrasound, duplex ultrasound is a non-invasive diagnostic tool that uses sound waves to capture images of both the superficial and deep venous systems, and of the movement of blood through the veins. It can detect reflux at malfunctioning valves, as well venous obstruction (Wittens 2015; Scherger 2012).

For the routine evaluation of venous disease, duplex ultrasonography has largely replaced other diagnostic techniques such as handheld Doppler and venography. Duplex ultrasound is also used to assess treatment results (Wittens 2015; Fort 2017a).

Air plethysmography. Air plethysmography is a noninvasive test that measures changes in leg volume. It gives information about venous reflux, obstruction, and calf muscle pump function. Although used less frequently since the advent of duplex ultrasound, its use is indicated when the results from duplex ultrasound are inconclusive (Wittens 2015; Fort 2017a; Dezotti 2017; Gloviczki 2011).

Venography. Venography is a more invasive and complex imaging modality that also has been largely supplanted by duplex ultrasound. However, it retains an important role in more advanced disease including post-thrombotic syndrome and is critical for venous evaluation prior to surgical procedures (Fort 2017a; Gloviczki 2011).