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Compression stockings for the initial treatment of varicose veins in patients without venous ulceration.

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Purpose: To define basic properties of the duplex ultrasound diagnostic test for reflux in veins of lower extremities, and to examine if some of the elements of this test can be standardized in order to improve reproducibility.Methods: This is a prospective multi-center study sponsored by the American Venous Forum Foundation. Vascular laboratories from 11 centers participated in protocol development, educational intervention, and data collection.Repeatability studies were performed as a duplicate test within 2 weeks between replicates performed by the same technologist, at the same time of the day, using the same reflux provoking maneuver, and with patient at the same position. Repeatability was separately examined for different combinations of patient position, reflux-inducing maneuvers, and time of the test.Reproducibility was examined by two different technologists, who performed the test at the same time of the day, using the same reflux provoking maneuver, and with the patient at the same position.Facilitated reproducibility was studied by examining the same patients by two different technologists immediately after an educational intervention at the central laboratory.In order to examine potential for decreasing in variability of results, limits of agreement between two duplex scans were studied by changing three elements of the test: time of the day (morning vs afternoon), patient's position (standing vs supine), and reflux initiation (manual vs automatic compression-decompression).Results: A total of 51 patients were examined by different technologists during four sessions at the central laboratory. At the time of this abstract submission, an additional 68 patients were examined at participating laboratories.Overall repeatability was 97.7%, with higher values for superficial veins and lower for deep veins. Reproducibility was lower, which indicates a potential for improvement by standardization. This was confirmed by better reproducibility after educational intervention (facilitated reproducibility).