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Duplex Sonography and Venography for Interventions

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PanVascular Medicine

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Abstract

Disorders of the superficial leg veins are very common. Ultrasound has become the principal diagnostic modality for the anatomy, physiology, and various disorders of the superficial veins. This caused a gradual change in the criterion standard of investigation of leg veins from venography to duplex sonography.

This chapter discusses the basics of flow and reflux in leg veins as represented by ultrasound. Different provocation maneuvers are described to elicit a blood flow that may result in a reflux. The ultrasound anatomy of the saphenous veins, their junctions, and the perforating veins is described, followed by a description of the typical flow patterns in healthy and incompetent valve situations.

Ultrasound is required to establish a diagnosis of leg vein insufficiency and to measure its extension into the lower extremities’ venous system, thus facilitating a treatment decision. It is also indispensable for most of the current treatment modalities before, during, and after the intervention. Ultrasound is of critical importance when deciding which treatment would be best and for identifying suitable (or unsuitable) treatment alternatives. It is excellent for postoperative evaluation, identification of complications, and both short- and long-term follow-up. The importance of duplex sonography for treatment is highlighted in this chapter. Also described are the use of ultrasound for preoperative decisions, mapping for stripping and conservative hemodynamic correction of venous insufficiency (CHIVA) or selective varicose vein ablation under local anesthesia, and intraoperative monitoring in foam sclerotherapy, external valvuloplasty, and endoluminal treatments of saphenous veins.

Although venography has been replaced by ultrasound to a large extent over recent decades, venography remains a comprehensive, fast method for the investigation of the venous system, with unsurpassed documentation. Venography not only allows detailed anatomic representation, but also qualitative and functional analyses. It is still the only method for the objective documentation of anatomic conditions and spatial interrelations, which may be of importance for the strategic planning of surgery and for the interpretation of the overall condition. However, today venography is only used in special, individual cases before performing surgery and interventions in the superficial venous system. Although magnetic resonance venography, computed tomography, and computed angiography are evolving, they do not yet represent standard diagnostic modalities for the superficial venous system; they are currently used for the diagnostic workup of iliac veins, for example.

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Abbreviations

AASV:

Accessory anterior saphenous vein

APSV:

Accessory posterior saphenous vein

CDU:

Color-coded duplex ultrasound

CUS:

Compression ultrasound

GSV:

Great saphenous vein

PW:

Pulsed wave

SFJ:

Saphenofemoral junction

SPJ:

Saphenopopliteal junction

SSV:

Small saphenous vein

VM:

Valsalva maneuver

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Authors and Affiliations

  1. Speckenstr. 10, 31515, Venenpraxis Wunstorf, Wunstorf, Germany

    Erika Mendoza

  2. T6 25, 68161, Praxis für Gefäßerkrankungen, Mannheim, Germany

    Horst Gerlach

Authors
  1. Erika Mendoza
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  2. Horst Gerlach
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Corresponding author

Correspondence to Erika Mendoza .

Editor information

Editors and Affiliations

  1. Division of Cardiovascular Disease Department of Internal Medicine, Health Care Center Bitterfeld, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Mendoza, E., Gerlach, H. (2015). Duplex Sonography and Venography for Interventions. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37078-6_241

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  • DOI: https://doi.org/10.1007/978-3-642-37078-6_241

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-37077-9

  • Online ISBN: 978-3-642-37078-6

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