[Physical diagnostics--duplex scanning is necessary only for selected patients with varicose veins]

With the advent of non-invasive duplex scanning, the imaging of the lower limb venous system has been greatly improved. Some authors routinely use duplex on their patients with varicose veins. However, this policy is associated with increased costs and demands a lot of logistics as well as the radiologists' time in clinics treating many of these patients. In view of the small difference in diagnostic accuracy compared to venography, duplex scanning is the gold standard for diagnosing patients with varicose veins in current practice. Recently the cheaper and simpler Doppler testing was compared with duplex scanning. In patients with primary varicose veins who have not previously been operated on, physical examination combined with Doppler can indicate more than 90% of V. saphena magna insufficiencies. However, Doppler misses approximately one-third of insufficient V. saphena parva (VSPs) and it is unable to localize the variable saphenopopliteal junction accurately. Since the incidence of VSP insufficiency in patients with primary varicose veins is only 15-33%, physical examination combined with Doppler investigation is sufficient to establish the correct diagnosis in the majority of patients. For recurrent varices, the sensitivity, specificity and negative predictive value of a Doppler investigation is marginal. In practice, duplex scanning is only indicated as follows; when VSP insufficiency is suspected, for recurrent varices, when signs of chronic venous insufficiency are present and when the findings from a physical examination combined with Doppler tests are inconclusive, e.g. in patients with adipose legs.