Duplex ultrasound examination of the acutely painful and swollen leg.

OBJECTIVE: The aim of this study was to assess the value of duplex ultrasound examination in establishing diagnosis in acutely swollen and painful lower limbs, and to examine how often the diagnosis of superficial and/or deep venous thrombosis can be made in the symptomatic legs. METHODS: Venous duplex scan examination was performed on 188 extremities of 180 ambulatory outpatients. The examination included testing patency and competency of the deep and superficial veins. The ultrasound study was also extended to finding soft tissue abnormalities. RESULTS: Of the 188 lower limbs venous thrombosis was found on 82 occasions: 29 legs contained deep venous thrombosis only; 23 legs presented with superficial thrombophlebitis as a sole venous pathology; and in 30 cases superficial and deep venous thrombosis coexisted. In those 106 limbs where venous thrombosis was not present the most frequent positive ultrasound findings were incompetent leg veins or soft tissue masses (Baker's cyst and calf haematoma). CONCLUSION: The variety of pathological processes related to the lower limb veins and the extravascular tissue suggest that routine, "detailed" ultrasound scanning would be indicated in all acutely symptomatic legs with a suspected venous disorder. The important diagnostic information so gained provides guidance to the most appropriate treatment strategy.

Anatomy of the superficial venous system.

BACKGROUND: A number of informative and detailed scientific communications have been published in recent years on the functional anatomy of the lower extremity venous system. OBJECTIVE: This paper is aimed at providing basic anatomic information for physicians interested in phlebology. It also highlights the new research areas and the changing concepts on the the pathophysiology of varicose veins. METHODS: The material is concentrated on observations made during duplex scan examination of the venous drainage of normal and abnormal limbs. RESULTS: The etiology and classification of varicose veins are discussed, followed by a description of the subcutaneous venous anatomy based upon ultrasound studies. The anatomy of venous reflux in different segments of the superficial venous system is examined in the light of recent duplex ultrasound findings. CONCLUSION: The presentation and treatment of varicose veins may vary depending on the anatomical distribution of valvular incompetence.

Anatomical examination of leg telangiectases with duplex scanning.

BACKGROUND: Earlier studies using Doppler ultrasound suggested that thigh telangiectasia might be associated with reflux in the larger subcutaneous veins. OBJECTIVE: The aim of the study was an accurate description of the anatomy of the venous drainage from thigh telangiectases and evaluation of the extent of venous valvular incompetence using a noninvasive imaging method. METHOD: High-definition color duplex ultrasonography was used to achieve the objective. RESULTS: Thirty-seven legs with lateral and/or medial thigh telangiectasia were examined. Patients studied were those without saphenofemoral, saphenopopliteal, or deep venous abnormalities on Doppler ultrasound examination. Altogether 53 sites were tested. In 89% reticular vein incompetence was found close to telangiectases. Often reticular vein incompetence was associated with reflux in larger epifascial veins. In 15% incompetent perforating veins were detected between reticular veins and the deep venous system. CONCLUSION: An accurate, functional reconstruction of the subcutaneous venous drainage was accomplished. It was found that telangiectasia was rarely an isolated condition, but was usually associated with incompetence in other elements in the venous drainage of the subcutaneous tissue.

Duplex scanning and light reflection rheography in the assessment of the severity of short saphenous vein incompetence.

BACKGROUND: Duplex ultrasound assessment of veins in the popliteal fossa is an accepted alternative to venography. Light reflection rheography provides additional quantitative information on venous reflux in chronic venous insufficiency. OBJECTIVE: To use duplex ultrasound and light reflection rheography to study the venous reflux patterns in the popliteal fossa in a group of patients. METHODS: Duplex ultrasound examination and light reflection rheography were used in the assessment of the severity of short saphenous vein incompetence. RESULTS: The study revealed that any associated deep venous reflux which was detectable beyond the saphenopopliteal junction represented a more advanced stage of superficial venous insufficiency. CONCLUSIONS: Light reflection rheography, as a semiquantitative test, provided useful additional information to duplex scan findings in assessing venous reflux of the popliteal fossa. Short saphenous vein reflux with functional deep venous incompetence was associated with shorter venous refilling times and clinically represented a more advanced stage of primary varicose vein disease.

Venous reflux patterns in the popliteal fossa.

Incompetent veins in the popliteal fossa were assessed with duplex ultrasound in 123 legs of 104 patients. In 91 cases the venous reflux was the result of a single incompetent vein draining into the deep system. In 32 cases duplex ultrasound demonstrated a combination of incompetent veins. With the exception of 3 patients duplex scanning accurately localised the incompetent veins and their "junctions" with the deep system. In 48 legs the reflux signal, detected in the surface vein, extended back beyond the "junction" into a proximal segment of the popliteal vein or superficial femoral vein; in most cases the distal popliteal vein remained competent. Six distinct venous reflux patterns were identified in the popliteal fossa, which seemed to correlate with the severity of related clinical symptoms.