Accuracy of clinical methods and doppler ultrasound in detection of incompetency of sapheno-femoral junction and perforators compared with operative results

Abstract

Background: Varicose veins, though a common condition, many time remains asymptomatic. The accurate diagnosis of varicose veins is of great importance in planning effective treatment. It is essential to bring out the accuracy of various diagnostic methods of varicose veins, so that early intervention can be achieved and recurrence can be prevented. The objective of this study was to our study was done with the intention of assessing the accuracy of Clinical evaluation of incompetence of Sapheno-Femoral Junction (SFJ) and perforators over doppler ultrasound evaluation and its Intra-operative confirmation, and also to assess the sensitivity, specificity, positive and negative predictive values and significance of both clinical as well as doppler ultrasound evaluation of varicose veins. Methods: The study was conducted in the in-patients of General Surgery Department from September 2011 to August 2013. Patients presented with dilated tortuous veins in lower limb(s) and operated were included in the study. Patients who had recurrent varicose veins and who were unfit for surgery were excluded from the study. The patients were first evaluated clinically using Brodie -Trendelenburg Test I and II, Tourniquet Test, Schwartz Test, Pratt's Test, Morrissey's Cough Impulse Test and Fegan's Method. Following this, patients were evaluated by Ultrasound Doppler study of Venous system of the Lower limb(s) and sites of perforator incompetence were marked. Intraoperative confirmation of incompetence was done by Turner Warwick's Bleed back sign. The accuracy of clinical methods and doppler ultrasound evaluation compared with operative findings were assessed. Results: Accuracy of clinical methods in detecting SFJ incompetence was checked with intra-operative findings. The sensitivity was 100%, specificity 100%, PPV 100% and NPV 100%. Similar results were obtained when checking the accuracy of doppler with intra-operative findings. Accuracy of clinical methods in detecting perforator incompetence was checked with intra-operative findings. The sensitivity was 82.93%, specificity 22.22%, PPV 90.67% and NPV 12.5%. Accuracy of doppler evaluation in detecting perforator incompetence was checked with Intra-operative findings. The sensitivity was 97.56%, specificity 12.5%, PPV 91.95% and NPV 33.33%. Conclusions: Diagnosis of varicose veins is essential for planning of treatment if needed. Clinical methods predict the diagnosis of incompetent SFJ and perforators for which patient need not spend money, and are easy to perform. But doppler ultrasound evaluation has been proved to be more reliable, non-invasive and compatible in detecting venous incompetence. Hence, we conclude that doppler ultrasound evaluation is more accurate than clinical methods in detecting incompetent veins.