It is only possible to show whether hand held Doppler is an acceptable proxy for duplex ultrasound or not. Hence showing that hand held Doppler has greater diagnostic accuracy than duplex ultrasound is not possible because any discrepancies between the two techniques will automatically be attributed to the superiority of the gold standard. This variation in practice necessitates a diagnostic review.Īs duplex ultrasound has been chosen as the gold standard in this review, the assumption is that it is the superior measure. This is on the basis that some clinicians believe it to be an adequate substitute for the more expensive and time-consuming duplex ultrasound, although hand held Doppler does not have the advantages of the grayscale ultrasound, which facilitates assessment of both the superficial and deep veins. Despite this, hand held Doppler ultrasound is still used for this purpose in some clinics. On a clinical basis, duplex ultrasound scanning is firmly established as the gold standard measure for assessing venous disease in the lower limb. Duplex ultrasound may therefore help in the pre-operative phase by mapping all varicose veins, tributaries and incompetent perforating veins. The source of filling of all superficial veins is also vital information provided by duplex ultrasound, as failure to identify and treat all sources of venous filling is likely to result in recurrence of varicosities. Such highly detailed information may help decide the type of treatment considered most appropriate, especially when considering minimally invasive endovenous procedures. When used to assess the veins in the lower limb, duplex ultrasonography is able to assess both the deep, superficial and perforating veins to give important information on anatomical patterns of veins, vein patency, vein diameters and valve function. Venous duplex ultrasonography may be performed in a vascular laboratory, X-ray department or an outpatient clinic setting with a vascular scientist, radiologist or vascular surgeon performing the procedure. Information on both structure and flow of blood in both arteries and veins is provided in a painless non-invasive manner. Over the last 20-30 years, non-invasive techniques have been developed which have distinct advantages over such invasive techniques.ĭuplex ultrasonography (also known as duplex ultrasound or duplex imaging) is a form of medical ultrasonography which uses the two components of grayscale ultrasound and Doppler ultrasound to image the blood vessels of the body. Historically, veins have been investigated using venography, which is a test using X-ray, needles and contrast agents.
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