[Diagnosis of incompetent perforators in primary varicose veins by high resolution ultrasonography]

The purpose of this study is to investigate morphological changes of incompetent perforators in primary varicose vein, and to elucidate diagnostic accuracy of high resolution ultrasonography regarding the incompetent perforators. The subjects were 42 lower limbs in 28 patients. Sixteen lower limbs had stasis symptoms and 26 had stasis dermal findings. Perforators were diagnosed when they penetrated the strong echo from the fascia. Their diameter was measured and their subfascial draining veins were identified. By operation, their penetrating portions on the fascia were confirmed and bleed back test was performed. They were divided into 8 types according to their draining veins. Eighty-nine perforators were detected and of them were major 3 types. The incompetent perforators arose at 3mm in diameter, and the all perforators more than 7mm became incompetent. The diagnostic accuracy of ultrasonography regarding their positions was 92%. However, the diagnostic accuracy of ultrasonography regarding their incompetency was 65% in total accuracy, when 4mm in diameter was used as a cut-off line. The positions of perforators were accurately detected using ultrasonography, but their competency was not precisely evaluated by diameter measurement. Therefore, this method was available for marking the precise position of incompetent perforators preoperatively.