PREOPERATIVE DUPLEX IMAGING IS REQUIRED BEFORE ALL OPERATIONS FOR PRIMARY VARICOSE-VEINS

Background Physical examination is unreliable in the detection of sour ces of reflux in varicose veins. Hand-held Doppler (HHD) ultrasonograp hy has been recommended as an accurate adjunct to physical examination . The aim of this study was to evaluate the accuracy of HHD imaging in comparison with duplex ultrasonography. Methods Eighty-nine legs in 6 1 patients with primary varicose veins were examined with an HHD probe to detect reflux at the saphenofemoral junction (SFJ), the saphenopop liteal junction (SPJ) and in thigh perforators (TPs). Patients then un denwent duplex imaging and the results of the tests were compared. Res ults The sensitivity of the HHD technique was 73 per cent at the SFJ, 77 per cent at the SPJ and 51 per cent for TPs. In primary varicose ve ins the surgery planned using HHD imaging alone would have left residu al sites of reflux in 24 per cent. Conclusion Examination with HHD ult rasonography is not sufficiently accurate to plan varicose vein surger y. Duplex imaging is recommended before all operations for primary var icose veins.