Clinical Role of the "Venous" Ultrasound to Identify Lower Extremity Pathology

Accreditation in peripheral venous testing can be obtained based on femoropopliteal (FP) duplex ultrasound evaluation, and many laboratories limit their examination to this segment only. This simplified protocol detects acute FP deep venous thrombosis (DVT) but misses calf vein DVT, superficial venous thrombosis, chronic DVT, venous reflux, and other nonvenous findings potentially responsible for the patients' presenting conditions. A protocol limited to the FP segment results in additional unnecessary testing and can create patient dissatisfaction. We evaluated the differences in the diagnosis between a limited FP versus a complete approach to the venous ultrasound evaluation of the lower extremities in patients examined in an outpatient vascular laboratory.

A database with the complete ultrasound examinations of the lower extremity including the common femoral, deep femoral, popliteal, tibial, and peroneal veins; calf muscular veins; great and lesser saphenous veins performed in 812 consecutive patients over an 8 month period was queried.

Acute FP DVT was found in (32 of 812) 3.94% of the patients. Chronic FP DVT was found in 6.65% (54 of 812). Acute infrapopliteal DVT was found in 4.06% (33 of 812). Chronic infrapopliteal DVT was found in 5.04% (41 of 812). Superficial venous thrombosis of lower extremities was found in 15.27% (124 of 812). In addition, deep venous insufficiency (>500 msec) was found in 49.75% (404 of 812) and superficial venous insufficiency in 31.28% (254 of 812; >500 msec). A mass (cyst, hematoma, solid mass, or aneurysm) was found in (23 cysts, 2 hematomas, 23 solid mass, 4 aneurysms) 6.4% (52 of 812).

Limited FP ultrasound examination for acute DVT would have only detected a small percentage of the positive findings. These data suggest that a complete duplex examination can be used to further delineate the cause of outpatients' symptoms compared to the limited protocol.