Standardized structured report for Doppler duplex ultrasound of lower extremity venous insufficiency and thrombosis: a technical note

Abstract

A standardized structured Doppler duplex ultrasound (US) report format for lower extremity venous system assessment has not been previously described. This technical note proposes a standardized, structured report for a complete Doppler duplex US protocol for evaluating lower extremity venous insufficiency and thrombosis. The protocol begins in the upper abdomen with an assessment of the heart, the ostium of the inferior vena cava (IVC), the caval hiatus, the entire course of the IVC, the iliac veins on both sides, and the entire course of the superficial and deep, perforator, and reticular venous system of the lower extremities. The diameter, compressibility, permeability, competence, velocity, thrombosis, or endothelial thickening in the transverse plane with compression maneuvers, the Valsalva maneuver, respiratory variation, and augmentation of one or both lower extremities are described according to the referring physician's request. Additional pathologic findings of varicose plexuses, incompetent perforating veins, thrombi, or surgical changes are reported. The proposed standardized structured report format, developed for educational purposes for radiologists and residents, is intended to improve accuracy and consistency of information. It also facilitates effective communication by providing relevant information to clinicians and patients.

US duplex findings in chronic venous insufficiency of the lower limbs in 500 Mexican patients

“…Our study shows a complete description of the US duplex findings of the four venous systems: perforating, superficial, deep, and reticular in patients with CVI of the lower limbs, highlights the complexity of CVI, and emphasizes the need for a comprehensive examination using structured and standardized reporting 10 . Further studies on the proposed classification of grades of reflux and long-term follow-up of patients and their correlation with the CEAP classification are needed.…”

“…The strengths of the study are the large sample of patients, that the examination was performed by a single radiologist with expertise in vascular US, and the protocol was complete 10 . The study limitations include the retrospective cross-sectional design, the lack of a healthy control group, and the fact that ultrasonography is an operator-dependent method that requires formal training and thorough knowledge of the anatomy, pathophysiology, and hemodynamics of the venous system to perform an optimal assessment.…”

“…The complete US protocol of the venous system of the lower limbs was performed as previously described by Figueroa et al 10 using the duplex US modalities: grayscale, duplex Doppler, color Doppler, power Doppler, and, more recently, B-flow examination. It began at the ostium of the vena cava, examined its entire course, and continued in the primitive and external iliac veins.…”

“…It directly demonstrates the patency and competence of venous valves, as well as flow direction and velocity 4,7,8 . Several protocols have been published that describe CVI findings with US duplex 9,10,11 . However, there is no standardized examination.…”