Ultrasound evaluation of lower extremity chronic venous disease

The clinical spectrum of lower extremity chronic venous disease is very wide, ranging from asymptomatic individuals with no physical findings (C0a) to severely impaired patients with very large non-healing ulcers (C6). All clinical forms of CVI are caused by valve incompetence (reflux) and/or venous outflow obstruction in the superficial, deep, and perforating veins. Venous reflux and/or obstruction can progress to severe venous hypertension with chronic inflammation and tissue damage. Duplex ultrasound (DUS) is the goal standard imaging technique for the diagnosis of valve incompetence and obstruction affecting any of the three lower extremity venous systems in patients with VLU. DUS is the single imaging modality to provide information on both, the anatomy and function of the infrainguinal veins. This article describes the sonographic anatomic and hemodynamic criteria used for the diagnosis of venous reflux and obstruction in patients with venous leg ulcers (VLU).