Presence and location of clinically relevant perforating veins and extent of possible alternative refluxing superficial venous pathways should also be included in any duplex US evaluation. Evaluation of venous structures should be accomplished via both transverse and longitudinal planes. Respiratory variation and cardiac pulsations are normally present and indicate a patent pathway to the heart [1]. The association between reflux and clinical manifestations of chronic venous disease is well established. Reflux, defined as retrograde venous flow >500 ms is almost always the result of primary degenerative changes within the venous wall and valves or as sequela of acute DVT causing destruction of venous valves [15]. Duplex Doppler US recordings should thus document presence, absence, and location of reflux. At a base level, abnormal reflux times should be measured and reported [16]. Variant 2: Varicose veins. Treatment. Compression Therapy Compression therapy has been widely described as the best initial treatment for varicose veins [18-20]. Compression therapy involves the use of a wide varying degree of devices to provide extrinsic compression on the lower extremity. As a group, they reduce venous stasis in various ways. Edema is contained by reduction of capillary filtration, fluid shift into noncompressed regions, and improved lymphatic drainage. Veins are directly affected by increasing venous blood flow velocity, reducing blood pooling, and improving venous pumping function. Lastly, microcirculation is influenced by transient increases in sheer stress, which in turn causes the release of anti- inflammatory, vasodilating, and antithrombotic mediators [19,21]. When using compression therapy, a minimum pressure of 20 to 30 mm Hg is recommended. Pressures of 30 to 40 mm Hg are advised for more severe disease [20].
Lower Extremity Chronic Venous Disease. Presence and location of clinically relevant perforating veins and extent of possible alternative refluxing superficial venous pathways should also be included in any duplex US evaluation. Evaluation of venous structures should be accomplished via both transverse and longitudinal planes. Respiratory variation and cardiac pulsations are normally present and indicate a patent pathway to the heart [1]. The association between reflux and clinical manifestations of chronic venous disease is well established. Reflux, defined as retrograde venous flow >500 ms is almost always the result of primary degenerative changes within the venous wall and valves or as sequela of acute DVT causing destruction of venous valves [15]. Duplex Doppler US recordings should thus document presence, absence, and location of reflux. At a base level, abnormal reflux times should be measured and reported [16]. Variant 2: Varicose veins. Treatment. Compression Therapy Compression therapy has been widely described as the best initial treatment for varicose veins [18-20]. Compression therapy involves the use of a wide varying degree of devices to provide extrinsic compression on the lower extremity. As a group, they reduce venous stasis in various ways. Edema is contained by reduction of capillary filtration, fluid shift into noncompressed regions, and improved lymphatic drainage. Veins are directly affected by increasing venous blood flow velocity, reducing blood pooling, and improving venous pumping function. Lastly, microcirculation is influenced by transient increases in sheer stress, which in turn causes the release of anti- inflammatory, vasodilating, and antithrombotic mediators [19,21]. When using compression therapy, a minimum pressure of 20 to 30 mm Hg is recommended. Pressures of 30 to 40 mm Hg are advised for more severe disease [20].