Venous duplex scanning of the leg: range, variability and reproducibility

Abstract

Despite the many studies on venous haemodynamics using duplex, only a few evaluated the normal values, variability and reproducibility. Therefore, the range and variability of venous diameter, compressibility, flow and reflux were measured. To obtain normal values, 42 healthy individuals (42 limbs, 714 vein segments) with no history of venous disease were scanned by duplex. To determine the reproducibility the intra-observer variability was measured in 11 healthy individuals (187 vein segments) and the inter-observer variability in 15 healthy individuals (255 vein segments) and 13 patients (169 vein segments) previously diagnosed with deep venous thrombosis. Of the 714 normal vein segments, 708 (99%) were traceable, including the crural veins. Of the traceable vein segments, 675 (95%) were compressible and in 696 (98%) flow was present. Of the 42 common femoral vein segments, in 25 (60%) the reflux duration exceeded 1.0 s, but in the other proximal vein segments the reflux duration was less than 1.0 s (95% confidence interval 3.0-10.0). With the exception of the distal long saphenous vein, in the distal vein segments the reflux duration was less than 0.5 s (95% confidence interval 3.5-8.2). The coefficient of variation of the diameter measurements ranged from 14 to 50% and that of the reflux measurements from 28 to 60%. The kappa-coefficient of the inter-observer variability in the classification of compressibility measurements in the patients was 0. 77 and that of the reflux measurements was 0.86. This study shows that almost all veins were compressible in healthy individuals, except the distal femoral veins. In healthy individuals the duration of reflux of the proximal veins was less than 1.0 s and in the distal veins it was less than 0.5 s. The inter-observer variability of the reflux and compressibility measurements in the patients was good.

A three-dimensional electronic report of a venous echo color Doppler of the lower limbs: MEVeC®

“…They found an interobserver variability coefficient for compressibility equal to 0.77, whereas according to reflux it was calculated as equal to 0.86 13. Such good results are in agreement with other previous papers,14 and pointed out the need for the correct setting of ultrasound machines, in order to achieve better results in the definition of the images, and in their reproducibility 15.…”

“…Interesting findings came from Haenen et al13 They tried to evaluate interobserver variability coefficients of common duplex ultrasound in patients previously diagnosed with deep venous thrombosis. They found an interobserver variability coefficient for compressibility equal to 0.77, whereas according to reflux it was calculated as equal to 0.86 13.…”

Multilayer compression bandaging in the acute phase of deep-vein thrombosis has no effect on the development of the post-thrombotic syndrome

“…Pathological reflux was defined as a reversed flow duration of more than 1 s in the proximal veins and more than 0.5 s in the distal veins. The kappa of the interobserver variability was 0.86 [12].…”

“…Both VOR and duplex are non-invasive tests with a good interobserver variability and can easily be used in studies and usual patient care [12,14]. Previously we demonstrated that the measurement of TS, VOR and reflux at three months follow-up can be used as a proxy or surrogate endpoint for PTS [2].…”

“…TS values were calculated by counting the TS values of the 10 vein segments. The kappa-coefficient of the interobserver variability was 0.77 [12]. Reflux was measured in the longitudinal plane.…”