Journal of Ultrasound in Medicine, Vol 15, Issue 2 143-154, Copyright © 1996 by American Institute of Ultrasound in Medicine
Preoperative imaging of lower extremity varicose veins: color coded duplex sonography or venography
M. M. Baldt, K. Bohler, T. Zontsich, A. A. Bankier, M. Breitenseher, B. Schneider and G. H. Mostbeck
Department of Radiology, University of Vienna Medical School, Austria.
We prospectively examined 137 limbs in 112 consecutive patients with
clinical evidence of severe varicosis by color coded duplex sonography and
ascending venography (including varicography in 48 limbs) to evaluate the
diagnostic capabilities of color coded duplex sonography in the assessment
of venous anatomy, variant varicosis, postthrombotic changes, and
incompetence of the superficial and perforating venous system.
Additionally, descending venography was performed in the first 52 limbs and
compared to color coded duplex sonography in the diagnosis of deep and
superficial venous reflux. Variant venous anatomy (21 cases) was missed in
two limbs and misinterpreted in one limb by ascending venography compared
to surgery. Color coded duplex sonography was inconclusive in two cases.
Variant varicosis (59 cases) was missed in seven surgically proved cases by
venography and in one case by color coded duplex sonography. Color coded
duplex sonography was inconclusive in five cases. Ascending venography was
slightly superior to color coded duplex sonography in the detection of
postphlebitic changes. Good agreement was found between color coded duplex
sonography and descending venography in the grading of superficial (k =
0.75) and deep venous reflux (k = 0.79). Excellent agreement was found
between ascending venography in the grading of long (k = 0.96) and short (k
= 0.94) saphenous vein reflux. More incompetent perforating veins were
detected by ascending venography, (and varicography) than by color coded
duplex sonography, but the latter technique allows direct preoperative
marking of the skin, which is beneficial for the surgeon. We conclude that
color coded duplex sonography is a valuable imaging tool before venous
stripping and is capable of replacing invasive ascending and descending
venography. Only patients with inconclusive color coded duplex sonographic
results (e.g., complex variant venous anatomy) should proceed to
venography.
