From the Guidelines
Venous ultrasound with Doppler imaging is the preferred diagnostic test for venous insufficiency. This non-invasive procedure combines traditional ultrasound imaging with Doppler technology to evaluate blood flow through the veins, particularly in the legs. During the examination, a technician will apply gel to the skin and move a handheld device (transducer) over the area being examined, focusing on the superficial and deep veins. The test typically takes 30-60 minutes and requires no special preparation, though loose-fitting clothing is recommended. Doppler ultrasound can detect reflux (backward flow) in the veins, visualize valve function, identify obstructions, and measure blood flow velocity—all key indicators of venous insufficiency.
Key Benefits of Venous Ultrasound with Doppler Imaging
- Highly accurate and completely non-invasive
- Involves no radiation exposure
- Provides real-time imaging of both the venous anatomy and blood flow dynamics
- Results are typically available immediately, allowing for prompt treatment planning
- Can differentiate between acute and chronic conditions and help determine the severity of the insufficiency
According to the most recent and highest quality study 1, duplex US should be the first assessment of the lower extremity venous system, as it is noninvasive and can evaluate direction of blood flow, assessment for venous reflux, and venous obstruction. Additionally, a study by Khilnani et al 1 notes that duplex US in patients with varicose veins in the posterior thigh, vulva, and inguinal regions can help identify venous escape points from reflux in the internal iliac venous system.
Limitations and Considerations
- US does have its limitations on body habitus and bowel gas and is operator dependent
- Three distinguishing sonographic criteria should be present to suggest the diagnosis of pelvic venous insufficiency: a dilated, tortuous pelvic vein >4 mm, slow or reversed blood flow (3 cm/s), and a dilated arcuate vein in the myometrium that communicates with pelvic varicosities 1
- If there are vulvar varicose veins, operators are rarely able to trace these vessels to a pelvic origin, and these examinations require a very experienced sonographer to acquire relevant information 1
From the Research
Diagnosis of Venous Insufficiency
To diagnose venous insufficiency, Doppler ultrasound or venous ultrasound are commonly used. The key aspects of these diagnostic techniques are:
- Color-Doppler sonography (CDS) is the main diagnostic technique for imaging chronic venous insufficiency (CVI) 2
- Doppler ultrasound provides both anatomical and functional information in a noninvasive, cost-effective, and radiation-free manner 3
- Evaluation of the superficial and deep venous system for degree and extent of reflux is necessary to establish the diagnosis and to institute appropriate treatment 3
Techniques and Findings
The techniques and findings for diagnosing venous insufficiency include:
- Sonographic examination must be performed in the upright and supine position 2
- Compression sonography and color and PW Doppler are systematically employed to assess the absence of deep venous thrombosis 2
- Femoro-popliteal veins are evaluated with color and PW Doppler for valvular insufficiency with reflux by performing Valsalva maneuver and calf compression 2
- Outward flow (lasting more than 500 ms) in the perforating veins should be considered a sign of their incompetence 2
Role of Ultrasound
The role of ultrasound in diagnosing venous insufficiency is:
- Duplex ultrasonography (DUS) is an essential part of the evaluation of patients with most forms of superficial venous insufficiency 4
- DUS has also become an important tool in directing and assessing the results of a variety of minimally invasive treatments of this disease 4
- Ultrasound evaluation of the lower extremity veins is the standard primary imaging technique for the initial evaluation of patients for whom there is clinical suspicion of deep venous thrombosis (DVT) 5