This paper is only available as a PDF. To read, Please Download here.
A prospective study comparing duplex scanning anddescending venography was applied
to 143 venous segments in 25 extremities with moderate to severe manifestations of
chronic venous insufficiency (class 2 or 3). Duplex scanning was performed with the
patient in the 15° reverse Trendelenburg position, and descending venography with
the patient in the 60° semi-erect position; the Valsalva maneuver was used to elicit
reflux in both tests. The duplex parameter of reflux duration greater than 0.5 second
correlated with venographic reflux in 94 of 105 segments (sensitivity of 90%). Conversely,
reflux time less than or equal to 0.5 second correlated with venographic competence
in 32 of 38 segments (specificity of 84%). A total of 17 discrepancies were identified
among the 143 total segments studied, for an accuracy of 88%. The largest proportion
of discrepancies was identified in the group with venographic competence and reflux
duration greater than 0.5 second and less than or equal to 2.0 seconds; this was designated
a gray zone. Mean peak velocities were significantly higher in the reflux group when
compared with the competence group in the profunda femoris vein (p=0.047), greater
saphenous vein (p<0.001), popliteal vein (p<0.001), and tibial vein (p=0.005).
We conclude that venographic reflux correlates best with duplex scan findings of reflux
duration greater than 0.5 second. Duration of reflux greater than 0.5 second and less
than or equal to 2.0 seconds, however, represents a gray zone and should be interpreted
with caution since this could lead to over-reading of reflux disease, in which case
verification of incompetence by descending venography may be indicated.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The etiology of leg ulcers and their treatment by resection of the popliteal vein.J Int de Chir. 1948; 8: 937-967
- Duplex scanning in the assessment of deep venous incompetence.J Vasc Surg. 1986; 4: 237-242
- Quantification of venous reflux by means of duplex scanning.J Vasc Surg. 1989; 10: 670-677
- Quantification of venous valvular reflux with duplex ultrasound scanning.J Vasc Surg. 1989; 10: 425-431
- Reporting standards in venous disease.J Vasc Surg. 1988; 8: 172-181
- Ascending and descending phlebography.in: Bergan JJ Kistner RL Atlas of venous surgery. 1st ed. WB Saunders, Philadelphia1992: 95-104
- A method of performing descending venography.J Vasc Surg. 1986; 4: 464-468
- Assessment of deep venous incompetence: a prospective study comparing duplex scanning with descending phlebography.Angiology. 1990; 41: 463-468
Neglen P, Raju S. Should duplex Doppler scanning replacedescending phlebography as the “gold standard” in evaluation of venous reflux? J Vasc Surg. (In press).
- Descending phlebography: a comparison of three methods and an assessment of the normal range of deep vein reflux.J Cardiovasc Surg. 1986; 27: 27-30
- The distribution of valves in the femoral, external iliac, and common iliac veins and their relationship to varicose veins.Surg Gynecol Obstet. 1952; 95: 537-542
- The valves of the external iliac, femoral and upper third of the popliteal veins.Surg Gynecol Obstet. 1951; 92: 453-455
- The mechanism of venous valve closure.Arch Surg. 1990; 125: 617-619
- Standing versus supine positioning in venous reflux evaluation.J Vasc Tech. 1991; 15: 321-324
Article info
Footnotes
*This work was supported by grants from the Garfield-King PeripheralVascular Fund and the Straub Pacific Health Foundation.
**Presented at the 20th Annual Meeting of the Society for ClinicalVascular Surgery, Orlando, Florida, March 25–29, 1992
Identification
Copyright
© 1992 Reed Publishing USA. Published by Elsevier Inc.
