Investigation of venous disease

Aim: To review the investigations which are performed in patients presentin g with varicose veins prior to treatment. Method: A review of current literature in the field of the investigation of venous disease of the lower limb has been conducted using MedLine. Synthesis: Continuous wave (CW) Doppler is effective in detecting venous re flux in the sapheno-femoral junction and the long saphenous vein. In the po pliteal fossa, for perforating veins and for the deep veins this technique has reduced accuracy. Duplex ultrasonography is widely used in the manageme nt of venous disease of the lower limb. This investigation provides reliabl e anatomical information but limited functional data about the veins. Phleb ography and varicography are effective investigations but are being replace d by duplex ultrasonography. Plethysmographic tests assess venous function but are poor at anatomical identification of the problem. They may be used in the monitoring of venous function during treatment and in identifying th e contribution of superficial venous reflux in patients with combined deep and superficial venous disease. Conclusion: Clinical examination is no longer sufficient to assess patients with venous disease of the lower limb prior to surgery. CW Doppler is the minimum investigation but duplex ultrasonography is the most effective non- invasive investigation. Plethysmographic tests have limited application in the management of varicose veins.