From the Guidelines
Diagnostic tests for venous leg ulcers should begin with a comprehensive clinical assessment, including a detailed patient history and physical examination, followed by duplex ultrasound scanning to evaluate venous reflux, obstruction, and rule out deep vein thrombosis, as recommended by the most recent study 1. The ankle-brachial pressure index (ABPI) is also an essential diagnostic test, with a normal range of 0.9-1.3 indicating venous disease rather than arterial insufficiency.
- Key diagnostic approaches include:
- Duplex ultrasound scanning to evaluate the condition of the deep venous system, great saphenous vein (GSV), small saphenous vein (SSV), and accessory saphenous veins, as well as the presence and location of perforating veins near a venous leg ulcer (VLU) 1.
- Imaging of the inferior vena cava (IVC) and iliac veins when there is a history of persistent venous ulcers or duplex US evidence of iliocaval obstruction, as suggested by Pascarella and Shortell 1.
- Additional tests, such as venography for detailed venous mapping, particularly when considering surgical interventions, and biopsy for ulcers with atypical appearance or those not responding to standard treatment to rule out malignancy.
- Laboratory tests, such as complete blood count, blood glucose, and inflammatory markers, to identify underlying systemic conditions.
- Wound cultures, if infection is suspected, though surface swabs have limited value compared to tissue samples. These diagnostic approaches help differentiate venous ulcers from other types of leg ulcers (arterial, neuropathic, or mixed etiology) and guide appropriate treatment strategies, ultimately improving morbidity, mortality, and quality of life outcomes for patients with venous leg ulcers 1.
From the Research
Diagnostic Tests for Venous Leg Ulcers
- Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes 2
- Diagnostic Doppler ultrasonography assesses deep, superficial, and perforator veins, starting from patency assessment by direct visualization and simply compression test 3
- Colour duplex ultrasonographic imaging has largely replaced venography in the assessment of lower-limb venous disorders 4
- Duplex ultrasound can be used to identify the source of superficial reflux in venous leg ulcers 5
Types of Diagnostic Tests
- Duplex ultrasound: used to assess venous competence in both the deep and superficial systems of the affected and unaffected legs 4
- Doppler ultrasonography: used to assess deep, superficial, and perforator veins 3
- Colour venous duplex imaging: used to assess venous competence in both the deep and superficial systems of the affected and unaffected legs 4
Importance of Diagnostic Tests
- Diagnostic tests are crucial in identifying the underlying cause of venous leg ulcers, which is essential for effective treatment 2, 3, 6
- Accurate diagnosis can help identify patients who may benefit from endovenous or surgical reflux abolition 2
- Diagnostic tests can also help identify patients who are at risk of complications, such as infection and malignant change 6