Imaging

Chronic Venous Insufficiency

Preliminary Diagnosis: Chronic Venous Insufficiency

I. What imaging technique is first-line for this diagnosis?

  • Ultrasound with Gray Scale, pulsed Doppler, and Color Doppler imaging.

II. Describe the advantages and disadvantages of this technique for diagnosis of chronic venous insufficiency.

Advantages

  • Gray-scale Imaging defines vein lumen, valve leaflets, and vein wall; assesses vein compressibility; and evaluates age of thrombus.

  • Pulsed-Doppler interrogation differentiates venous from arterial flow and documents venous flow pattern and flow direction and timing of duration of venous reflux.

  • Color-Doppler interrogation differentiates partial thrombosis from occlusion, distinguishes deep from superficial venous reflux at saphenofemoral and saphenopopliteal junctions, identifies incompetent perforating veins, and demonstrates recanalization of chronically thrombosed venous segment and collateralization.

  • Does not require ionizing radiation

Disadvantages

  • Requires some patient cooperation in various positions to acquire best-quality images

  • Operator dependent in obtaining high-quality images

III. What are the contraindications for the first-line imaging technique?

No significant contraindications exist.

IV. What alternative imaging techniques are available?

No other considerable appropriate alternative imaging techniques.

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