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Preoperative duplex imaging is required before all operations for primary varicose veins
K G Mercer1, D J Scott, D C Berridge
1Department of Vascular, St James's and Seacroft University Hospital NHS Trust, Leeds, UK.
Insights
Hand-held Doppler (HHD) ultrasonography is not accurate enough for planning varicose vein surgery. Duplex imaging is recommended for precise detection of reflux sites before operations.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Medical Ultrasonography
Background:
- Physical examination has limitations in identifying reflux sources in varicose veins.
- Hand-held Doppler (HHD) ultrasonography is a proposed tool to aid physical examination.
- The diagnostic accuracy of HHD requires further evaluation against established methods.
Purpose of the Study:
- To assess the accuracy of HHD imaging in detecting reflux in primary varicose veins.
- To compare the diagnostic performance of HHD with duplex ultrasonography.
- To determine the suitability of HHD for surgical planning in varicose vein treatment.
Main Methods:
- Eighty-nine legs from 61 patients with primary varicose veins were examined.
- HHD ultrasonography was used to detect reflux at the saphenofemoral junction (SFJ), saphenopopliteal junction (SPJ), and thigh perforators (TPs).
- Results from HHD were compared with findings from duplex ultrasonography.
Main Results:
- HHD demonstrated sensitivities of 73% at the SFJ, 77% at the SPJ, and 51% for TPs.
- Surgery planned solely with HHD could have missed 24% of residual reflux sites.
- These findings indicate significant limitations in HHD's diagnostic capability for surgical planning.
Conclusions:
- HHD ultrasonography alone is insufficiently accurate for planning varicose vein surgery.
- Duplex imaging is recommended as the preferred method before surgical intervention for primary varicose veins.
- Accurate pre-operative imaging is crucial for successful varicose vein treatment outcomes.
Background:
Physical examination is unreliable in the detection of sources of reflux in varicose veins. Hand-held Doppler (HHD) ultrasonography has been recommended as an accurate adjunct to physical examination. The aim of this study was to evaluate the accuracy of HHD imaging in comparison with duplex ultrasonography.
Methods:
Eighty-nine legs in 61 patients with primary varicose veins were examined with an HHD probe to detect reflux at the saphenofemoral junction (SFJ), the saphenopopliteal junction (SPJ) and in thigh perforators (TPs). Patients then underwent duplex imaging and the results of the tests were compared.
Results:
The sensitivity of the HHD technique was 73 per cent at the SFJ, 77 per cent at the SPJ and 51 per cent for TPs. In primary varicose veins the surgery planned using HHD imaging alone would have left residual sites of reflux in 24 per cent.
Conclusion:
Examination with HHD ultrasonography is not sufficiently accurate to plan varicose vein surgery. Duplex imaging is recommended before all operations for primary varicose veins.