[Functional exploration of the deep venous system by duplex]

The development of new direct methods for treatment of deep venous insufficiency requires improvement of the ultrasonographic investigation of valve function. The combination of imaging and pulsed Doppler provides more accurate diagnoses and can be used to establish deep venous hemodynamic cartography. Four essential rules must then be followed: an examination in standing position, proximal decompression tests, examination by one third segments and by thirds of each segment, analysis of the forgotten veins of the leg (soleus, gemellar) and thigh (profunda femoris, quadriceps, posterior ischiatic anastomotic flow) and of the deep muscular anastomoses. The hemodynamic direction of each feature of the venous map is then noted. This investigation enables the following in the context of disease: the diagnosis of deep venous pain affecting an apparently non-varicose area; precise monitoring of the post-thrombotic status of a deep vein, avoiding diagnostic errors related to a painful repermeation syndrome; preselection of cases of deep venous insufficiency suitable for anatomical surgical treatment or a hemodynamic technique (CHIVP) as indicated by the deep hemodynamic cartography which this investigation makes possible.