In the claudicating sportsperson, where there are no well characterised specific anatomical abnormalities, the syndrome can be characterised by provocative clinical (particularly hopping) and non-invasive tests. A positive clinical outcome with surgery can be predicted by abnormal pre-surgical ultrasonic investigations and confirmed later by a similar normal post surgical study. Concomitant venous compression may occur while standing with both syndromes related to muscle hypertrophy.
Background: Duplex ultrasound is the first line of investigation for patients seeking treatment for varicose veins disease. In Australia, chronic venous insufficiency ultrasound examinations (CVI-US) are primarily performed by sonographers. The use of clinical guidelines facilitates the practice of ultrasound, and more importantly, provides an assurance to the integrity and quality of the examinations. Our aim is to assess the quality of currently available guidelines and provide recommendations for choosing the appropriate guideline to use and suggestions for future guideline development. Method: We performed a systematic literature search of the Cochrane, EMBASE, EBSCO, Medline, PubMed, Google and the database of the University of Sydney. The scope covered guidelines from 2000 to 2020 available in English. Identified guidelines were appraised by four independent reviewers (sonographers) using the revised version of the Appraisal of Guidelines Research and Evaluation instrument. Results: A total of 10 guidelines were included for critical appraisal. Analysis of the results showed most guidelines were rated low quality except for the International Union of Phlebology consensus document (2006) and technical guideline by Zygmunt and colleagues (2020). Overall, Domain 1 (Scope and purposes) achieved the highest score (total score = 67.9% ± 17.3%), whereas, Domain 3 (Rigour of development) had the lowest score (total score = 41.1% ± 13.5%). Conclusion:The overall quality of CVI-US guidelines is poor. This study highlights the demand for developing ultrasound guidelines based on methodologically sound principles along with updated scientific evidence. A stronger emphasis should be given to clinical applicability in the Australian context.
Introduction: Due to the increasing prevalence of kidney failure in Australia, more sonographers are being expected to perform ultrasound examinations of arteriovenous fistulae (AVF), even when they may receive little support to do so. Methods:We surveyed respondents through the Australasian Sonographers Association (ASA), regarding their demographics, workplace, and experience in relation to AVF ultrasound examinations.Results: Fifty sonographers participated from metropolitan and regional areas.Sonographers in metropolitan areas had approximately three times more access to support compared to those in rural/remote areas, in performing AVF ultrasound examinations. Self-reported competency levels of AVF ultrasound examinations were novice/advanced beginner 28.6%, competent 30%, proficient/expert 40%. Less than a fifth of sonographers always performed a physical assessment, while almost half never physically assessed an AVF. Conclusion:Rural and remote sonographers have the least access to ongoing resources and support. The knowledge of the supporting role that non-ultrasound methods of AVF surveillance can play in improving the quality of ultrasound assessments, varied mainly by perception of competency. Sonographer competency, education, and support in AVF assessment is vital to avoid clinical uncertainty. Australian sonographers would benefit from further education and support to improve competency, confidence and patient outcomes.
The assessment of the saphenofemoral junction (SFJ) is important in the diagnosis and treatment of venous reflux of the great saphenous vein (GSV). In the clinical practice of venous medicine, the SFJ is used to represent the region at which the saphenous arch connects with the common femoral vein (CFV). A number of notable variations of the SFJ have been documented, and rare variable courses of the GSV have been described recently. Our case study reports two unusual GSV terminations. In both cases, the SFJ was located below the confluence of the profunda femoris vein (PFV) with the femoral vein (FV). Case 1 showed the SFJ was formed by the GSV and FV; whereas case 2 showed the PFV was joined by the GSV after a transposition with the FV. Anatomical variations of the SFJ are rare; however, they are increasingly diagnosed with the use of duplex ultrasound. The identification of SFJ variants warrants a safe endovenous procedure and prevents surgical complications.
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