An "All-Comers" Venous Duplex Scan Policy for Patients with Lower Limb Varicose Veins Attending a One-stop Vascular Clinic: Is It Justified?

Abstract

Objective: To determine whether clinical assessment could predict the correct management of patients with varicose veins (VVs), select those who would need duplex scanning, and identify deep venous reflux (DVR). Methods: Prospective study of 342 consecutive limbs with VVs. These were divided into 3 groups: 170 (50%) limbs with primary VVs without skin changes (group I), 37 (11%) with recurrent VVs without skin changes (group II), and 135 (39%) with primary or recurrent VVs with skin changes (group III). Clinicians were asked to document whether they would normally request a duplex scan because of clinical uncertainty. Agreement between decision-making based on clinical and on duplex findings was documented. Results: Agreement between clinical and duplex findings for groups I, II, and III was 82%, 59%, and 67%, respectively. In 112 cases (66%) in group I, clinicians felt certain about the diagnosis and yet duplex scanning revealed they were wrong in 12% of cases. In group II, clinicians would request a duplex scan because of clinical uncertainty in 30 (81%) cases. In group III, the sensitivity, specificity, positive and negative predictive value of clinical assessment in detecting DVR was 32%, 77%, 24%, and 83%, respectively. Conclusions: Clinical evaluation of patients with VVs is unreliable in planning their management. Clinicians can neither predict those who will require duplex scanning nor correctly identify DVR. Even experienced surgeons often "get it wrong" when assessing primary uncomplicated veins despite being certain about the diagnosis. Therefore, an "all-comers" duplex imaging policy should be implemented if optimal management is to be achieved. © 2006 Elsevier Ltd. All rights reserved.