From the Guidelines
To evaluate for superficial thrombosis in varicose veins, order a duplex ultrasound of the affected limb, as it is the gold standard for diagnosing superficial thrombophlebitis and can rule out deep vein thrombosis (DVT) 1. This non-invasive imaging test combines traditional ultrasound with Doppler flow assessment, providing both anatomical information about the veins and functional information about blood flow. When ordering, specify "venous duplex ultrasound" of the affected extremity with a clinical indication of suspected superficial thrombophlebitis in varicose veins. The ultrasound will visualize the thrombus, assess its extent, and importantly, rule out deep vein thrombosis (DVT), which can coexist in up to 25% of cases and requires different management, as noted in a study from 1. Additionally, consider basic laboratory tests including D-dimer, complete blood count, and C-reactive protein to assess inflammation and rule out systemic involvement. Duplex ultrasound is preferred because it provides a comprehensive evaluation of the venous system, allowing clinicians to determine the exact location and extent of thrombosis, evaluate for extension into the deep venous system, and guide appropriate treatment decisions, as recommended by the Society of Radiologists in Ultrasound Consensus Conference in 1. Some studies, such as 1, discuss various treatment options for varicose veins, but the primary concern in this context is diagnosing superficial thrombosis, for which duplex ultrasound is the most appropriate test.
From the Research
Diagnostic Tests for Superficial Thrombosis in Varicose Veins
- The diagnostic test used to detect superficial thrombosis in varicose veins is duplex ultrasound examination 2, 3, 4, 5, 6.
- Duplex ultrasound is used to estimate the extent of the thrombus, exclude deep venous thrombosis, and for follow-up 2, 5.
- It is recommended to check both legs with ultrasound, as simultaneous deep venous thrombosis can develop on the contralateral limb 2.
- A clinical examination is also necessary, especially in cases of spontaneous, non-varicose form, to exclude malignant diseases and thrombophilia 2, 3, 6.
Importance of Diagnostic Tests
- Diagnostic tests are crucial in identifying superficial thrombosis in varicose veins, as it can propagate to the deep veins in 6-44% of cases and lead to pulmonary embolism in 1.5-33% of cases 2.
- Accurate diagnosis is essential to determine the appropriate treatment and prevent complications 3, 4, 5, 6.
- Duplex ultrasound examination is a valuable tool in the diagnostic work-up of superficial vein thrombosis, allowing for the assessment of the extent of the thrombus and the exclusion of deep venous thrombosis 4, 5.