Duplex ultrasound (DUS) has become the gold standard for evaluating signs and symptoms of venous insufficiency. The test can be performed in 20-60 minutes directly in the office to provide information on vein disease and vein reflux. The examination is best performed by a registered ultrasound technician for accuracy and quality. A proper vein specialists in NJ should also be knowledgeable in both the performance and reading of venous ultrasound.
It is recommended that symptomatic patients with leg pain or leg swelling who have physical findings consistent with CEAP stages 2-6 undergo clinical evaluation with duplex ultrasound for detection of chronic venous insufficiency.
For superficial venous evaluation, the primary veins that are evaluated on ultrasound include the GSV, SSV and their primary tributaries. The ultrasound should be performed with pulse wave doppler using a linear 7.5-10MHz transducer. The end goal is to identify incompetent truncal veins and perforator veins. The deep system should also be carefully evaluated to exclude any disease. The vein specialists NJ utilize modern guidelines from the American College of Phlebology to ensure proper performance and documentation of exams.
The exam is generally performed in the standing position, though reverse trendelenburge can be also considered in patients vulnerable to vagal episodes or dizziness with prolonged standing. During examination, the veins are evaluated for size, wall characteristics, debris, and vein reflux. The venous reflux portion is measured with pulse wave doppler and is assisted by augmentation maneuvers. Venous blood flow is characterized by movement of blood towards the heart and any incompetent valves can be detected by abnormal reflux or regurgitation exceeding 500 milliseconds on doppler ultrasound. Vein doctors in New Jersey are expected to review these results prior to vein treatment recommendations. Vein Clinics in New Jersey will recommend treatment based on symptoms and ultrasound findings that are consistent. Insurance coverage for vein treatment in New Jersey is carrier specific and should be discussed in detail with the vein doctor New Jersey before proceeding.
Duplex ultrasound is also just as important in the follow up after vein treatment for varicose veins. Radiofrequency ablation and sclerotherapy are effective methods to cure spider veins and varicose veins, however duplex ultrasound permits post treatment monitoring for effectiveness and safe outcomes, such as excluding endovenous heat induced thrombosis (EHIT) from ablation. There are 4 stages of EHIT that are closely examined in the post procedure follow up ultrasound.
As such, DUS is required for diagnosis, pre-treatment planning, and follow up after vein treatment with radiofrequency ablation, laser ablation , sclerotherapy and venaseal.
