A simplified approach of 'DJPA' (DVT, Junctions, Perforators, Assessment of GSV diameter and anatomic variant) was found easy and reproducible resulting in short scanning times.

LEARNING POINTS

Venous insufficiency is a cause of substantial morbidity and medical expenditures. Diagnostic US evaluation of venous insufficiency requires a thorough understanding of the venous anatomy, including the deep, superficial, and perforator veins. The highly variable venous anatomy requires that operators use sound judgment to expand on protocol images and thus avoid missing important sources of reflux. The US examination requires specific patient positioning and the use of provocative maneuvers. A basic understanding of the pathophysiology of venous insufficiency and the various treatment methods helps to identify key observations so that ineffective treatment methods are not pursued. The examination reports should have greater detail than those for the more common lower extremity deep venous thrombosis evaluation, requiring numeric and narrative descriptions of deep and superficial venous patency, reflux, diameter, and pathways. Potential pitfalls include not recognizing or detecting deep venous reflux, misidentifying common femoral vein reflux as deep venous reflux when the reflux is isolated or related to saphenofemoral insufficiency, not recognizing anterior accessory great saphenous vein (AAGSV) involvement in saphenofemoral insufficiency, not recognizing or reporting great saphenous vein or AAGSV superficialization, not suspecting central venous obstruction, and not realizing when provocative maneuvers were ineffective. With knowledge of the lower extremity venous anatomy, venous insufficiency pathophysiology, basic treatment strategies, protocol best practices, patterns of observation, and diagnostic pitfalls, those who interpret venous insufficiency US studies can perform examinations and deliver reports that help patients receive appropriate treatment.

Duplex ultrasound is an important tool in the assessment and management of patients with varicose veins. Ultrasound parameters, such as the diameter of superficial incompetent veins or their depth from the skin surface, and competency of junctions and perforators have become of paramount importance for planning a tailored either operative or non-operative treatment. The standardization of the reporting of these ultrasound findings in patients with varicose veins improves communication between healthcare professionals and the management of these patients.