[What complementary examinations to demand in chronic venous insufficiency?]

The diagnosis of chronic venous insufficiency (CVI) is first of all a clinical diagnosis. Subsequent investigations are useful to elucidate the underlying abnormalities in the venous system and to quantify their severity. Continuous wave doppler ultrasound is the basis test. Duplex scanning is useful for the study of popliteal and tibial veins reflux. The others non invasive techniques aim to investigate patients with severe CVI. But it seems necessary to be very careful with the methodologies used with these tests, and there is a need for a test of the whole calf venous pump function. Venographic studies are performed only if it is necessary to complete the non invasive tests data, before surgical treatment of a postthrombotic syndrome or of congenital deep venous reflux, or when a rare form of CVI is suspected. Venography remains the better test for the study of the anatomy of the venous system, but it is no longer the gold standard for the investigation of CVI.