[Non-invasive exploration of the deep veins. Therapeutic implications in varicose patients]

The functional investigation of patients with varicose veins allows essential varicose veins to be distinguished from secondary varicose veins, so that appropriate therapy can be instituted. These investigations include global evaluation of the venous function, plethysmography and segmental ultrasonography. The authors propose a protocol combining Doppler with photoplethysmography: - if the deep channels are normal on the Doppler examination and the filling time of the PPG is normal after a venous tourniquet has been applied, the varicose veins are essential; - if the deep channels are abnormal: in the case of an obstructive or restrictive syndrome, the PPG can determine whether the varices act as collaterals and should be left intact or whether saphenous incontinence is partially or totally responsible for the disorders, in the case of reflux diagnosed on the Doppler, the PPG can decide whether or not this deep reflux is pathological. This simple, non-invasive protocol can be proposed in the majority of patients with varicose veins. It allows a better evaluation of the pathogenic influence of deep reflux, which is currently an subject of debate.