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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.
The British Journal of Surgery
|November 21, 1998
Summary
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.