[Diagnosis of venous disease]

Venous disease of the lower extremities comprises several common conditions such as varicose veins, superficial thrombophlebitis, deep venous thrombosis and chronic venous insufficiency. The high prevalence and increasing incidence with age of these disorders impose relevant diagnostic and therapeutic concerns. Varicose veins and superficial thrombophlebitis are easily diagnosed clinically and additional diagnostic means, i. e., duplex scan, is needed for documentation or planning of surgery. Deep venous thrombosis cannot be confirmed clinically and further imaging based on clinical probability is usually required for correct diagnosis. Color-coded duplex and compression sonography have emerged as the means of choice in skilled hands. Phlebography still remains the gold standard based on its investigator-independent characteristics. However, it is becoming more and more a research tool. CT scan and magnetic resonance imaging are too expensive for broad application, but may be helpful in cases of uncertainty such as iliac vein thrombosis. CT scans, magnetic resonance imaging and sonography reveal additional information compared to phlebography about surrounding tissue and may help in establishing a differential diagnosis. Limitations of CT scan and phlebography are radiation exposure and contrast media application. Chronic venous insufficiency is basically established by medical history and clinical findings. Functional and imaging tests such as plethysmography, color-coded duplex sonography and phlebography are essential for confirming the diagnosis, evaluating a surgical intervention or defining the cause of chronic venous insufficiency.