PREOPERATIVE IMAGING OF LOWER-EXTREMITY VARICOSE-VEINS - COLOR-CODED DUPLEX SONOGRAPHY OR VENOGRAPHY

We prospectively examined 137 limbs in 112 consecutive patients with c linical evidence of severe varicosis by color coded duplex sonography and ascending venography (including varicography in 48 limbs) to evalu ate the diagnostic capabilities of color coded duplex sonography in th e assessment of venous anatomy, variant varicosis, postthrombotic chan ges, and incompetence of the superficial and perforating venous system . Additionally, descending venography was performed in the first 52 li mbs and compared to color coded duplex sonography in the diagnosis of deep and superficial venous reflux. Variant venous anatomy (21 cases) was missed in two limbs and misinterpreted in one limb by ascending ve nography compared to surgery. Color coded duplex sonography was inconc lusive in two cases. Variant varicosis (59 cases) was missed in seven surgically proved cases by venography and in one case by color coded d uplex sonography. Color coded duplex sonography was inconclusive in fi ve cases. Ascending venography was slightly superior to color coded du plex sonography in the detection of postphlebitic changes. Good agreem ent was found between color coded duplex sonography and descending ven ography in the grading of superficial (k = 0.75) and deep venous reflu x (k = 0.79). Excellent agreement was found between ascending venograp hy and color coded duplex sonography in the grading of long (k = 0.96) and short (k = 0.94) saphenous vein reflux. More incompetent perforat ing veins were detected by ascending venography (and varicography) tha n by color coded duplex sonography, but the latter technique allows di rect preoperative marking of the skin, which is beneficial for the sur geon. We conclude that color coded duplex sonography is a valuable ima ging tool before venous stripping and is capable of replacing invasive ascending and descending venography. Only patients with inconclusive color coded duplex sonographic results (e.g., complex variant venous a natomy) should proceed to venography.