Duplex Ultrasound (DUS) is the primary diagnostic test of choice in patients with Chronic Venous Disease (CVD). It provides informations about venous anatomy, patency, vein wall pathology and flow and it is the most frequently used investigation to evaluate the outcome of treatments for CVD.
An analysis of the available literature was carried out and the out standing points were summarized to underline the importance of standardized DUS reports.
Three points have been pointed out to obtain a useful post-operative DUS examination:
• Pre-treatment DUS assessment should be available to
better evaluate the post-operative findings
• Details of treatment (traditional surgery, endothermal
ablation, Ultrasound guided Foam Sclerotherapy etc) should be
known
• Timing of DUS follow up.
DUS can detect the early stages of recurrent varicose veins and can help to comprehend the clinical evolution of the disease after any treatment for CVD. Furthermore, long term follow up using DUS allows to understand the natural history of CVD.
Timing of DUS follow up:
Post treatment DUS evaluation should be performed within 1-4 weeks (Immediate Follow up) to assess if the intervention has achieved the desired goal and late to assess the appearance of any recurrencies or of new varicose veins.
Than the follow up could be at short term (within 1 year), mid term (2-3 years after treatment), long term (>5 years after treatment) if possible till 10 years.
A correct DUS should describe the presence of neovascularization at the sapheno-femorale and sapheno-popliteal junction, the presence of a residual stump or of an incompetent anterior accessory saphenous vein.
It is essential evaluating a possible progression of thrombosis beyond the valvular plane with the deep system (EndoThermal Heat-Induced Thrombosis or EITH). The term EHIT was first introduced in 2005 by Kabnick et al.
This classification includes 4 stages of EHIT:
- thrombus propagating to the sapheno-femoral or sapheno-popliteal junction;
- thrombus propagating into the adjacent deep vein but less than 50%;
- thrombus propagating into the adjacent deep vein but greater than 50%;
- occlusive deep vein thrombosis.
A good occlusion of the GSV (great saphenous vein) may be flush with the epigastric vein. An acceptable saphenous stump should not exceed 2-3cm.
Finally, All the records should be reported to allow the detection of any recurrent varicose vein and to address the best re-treatment.
