The Role of Duplex Ultrasound Before, During, and After Endovenous Procedures

Abstract

Duplex ultrasound is a critical component of the evaluation of patients with venous insufficiency, as well as being of great value during endovenous procedures and also postprocedure to assess results. Although history and physical exam may identify some venous abnormalities and physicians-in-training are still taught to assess the venous system by physical exam, physical exam is limited in assessing the full range of potential venous abnormalities, particularly those below the skin surface that cannot be easily visualized. Obvious venous diseases such as ulcers, lipodermatosclerosis, visible varicosities, and superficial thrombophlebitis can be identified by physical exam; however, duplex ultrasound is required to determine the anatomy and the location, etiology, and severity of most cases of chronic venous insufficiency. The duplex ultrasound findings of venous thrombosis or occlusion, venous valvular reflux and dilatation, and agenesis or hypoplasia of the superficial and/or deep venous system at various locations in the lower extremity are the key to determining treatment options.