The Role of Duplex Ultrasound Before, During, and After Endovenous Procedures

Abstract

Duplex ultrasound (DU) is an important imaging tool in the diagnosis and classification of venous insufficiency, as well as in the assessment of patients who are candidates for an endovenous procedure. In the initial patient evaluation, DU determines the location of truncal reflux, the size of each abnormal vein, and the presence of adjacent incompetent veins. DU also evaluates other causes of chronic venous insufficiency, such as perforator vein incompetence, prior DVT and/or SVT. During endovenous treatment procedures, DU guides needle access, facilitates sheath placement, images passage of the endovascular device within the vein, and locates the tip of the catheter tip with respect to the deep venous system. In patients undergoing truncal thermal ablation, DU is also used during placement of tumescent solution around the target vein. In chemical ablation procedures, DU is used during the process of infusion to determine the proximal extent of the solution, identify movement of the foam into the deep system, identify the expected spasm within the treated vein, and for transducer compression to prevent extension of the chemical solution into the deep system. For endovenous perforator procedures, DU guides needle and catheter placement in the vein at the level of the fascia. Following endovenous treatment, DU assesses the success of ablation, extent of the venous closure, and complications such as hematoma, DVT, and endovenous heat-induced thrombosis.