Duplex Ultrasound

Duplex ultrasound is the most frequent investigation used to evaluate the venous system.  It aids in the management of venous disease of the lower limb and in planning which would be the best treatment.

Dulpex ultrasound is a combination of real time B-mode scanning with a pulsed doppler display.  Duplex imaging is used in combination with colour doppler imaging.  The B-mode imaging gives information on anatomical and pathological abnormalities or variants.  Colour gives information on the direction of blood flow and the pulsed wave allows a measure of reflux time ie the duration of incompetent or reverse flow.

Using these tools can provide a very detailed map of the venous system in the legs.  The deep veins are imaged prior to treatment to ensure there is no abnormality such as a deep vein thrombosis.  Compression and flow augmentation is used to rule out underlying deep vein pathology and to check for evidence of reflux.  The superficial system (containing the saphenous veins and tributaries) are imaged and a colour coded map is made demonstrating diameters, anomalous anataomy, venous aneurysm, perforator veins and the presence and extent of reflux if present.  Compression is used to identify the presence of thrombophlebitis (clots).

From the detailed information provided in the map a decision can be made regarding the most suitable treatment plan for each individual. 

Summary

Ultrasound Assessment of Varicose Veins

1. To rule out underlying deep vein pathology, particularly reflux and deep vein thrombosis

2.  To identify and map both normal and refluxing superficial veins making note of vein size, location and any aneurysmal dilatation.

3.  To identify and record any abnormality in the superficial venous system such as superficial thrombophlebitis (STP).

4.  To record perforator location and size particularly those related to skin pathology.

5.  To document and where possible categorise incidental and potentially confusing pathology such as a Bakers cyst, fluid lake or oedema. 

References

Applied Physics and Technology of Diagnostic Ultrasound by Roger Gent

Making Sense of Vascular Ultrasound by Kenneth Myers and Amy Clough