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The GSV, a superficial vein, is the longest vein in the body. It has its origin in the dorsal venous arch of the foot, a superficial vein which connects the small saphenous vein with the GSV. It travels up the leg and medial side of the thigh to reach the groin, where it drains into the common femoral vein. [32]
A duplex ultrasound (doppler ultrasonography and b-mode) can detect venous obstruction or valvular incompetence as the cause, and is used for planning venous ablation procedures, but it is not necessary in suspected venous insufficiency where surgical intervention is not indicated. [10] [6]
The risk of deep vein thrombosis can be estimated by Wells score. Lower limbs venous ultrasonography is also indicated in cases of suspected pulmonary embolism where a CT pulmonary angiogram is negative but a high clinical suspicion of pulmonary embolism remains. [1] It may identify a deep vein thrombosis in up to 50% of people with pulmonary ...
Doppler ultrasound is preferable rather than venography to access the competence of the veins. Local sepsis of the lower limbs is contraindicated for this procedure. Low osmolar contrast agent with concentration of 240 mg/ml is preferable in this study. Before the procedure, oedematous leg, if any, should be elevated overnight to reduce the oedema.
Venous refill with dependency (should be less than 30 seconds) – the vein should bulge outward within 30 seconds of elevation for one minute. Buerger's test (assessment of arterial sufficiency): With the patient supine, note the colour of the feet soles. They should be pink. Then elevate both legs to 45 degrees for more than 1 minute.
Telangiectasia in the legs is often related to the presence of venous reflux within underlying varicose veins. Flow abnormalities in smaller veins known as reticular veins or feeder veins under the skin can also cause spider veins to form, thereby making a recurrence of spider veins in the treated area less likely.
The result is edema, pain and a white appearance (alba) of the leg. The next step in the disease progression is occlusion of the superficial venous system, thereby preventing all venous outflow from the extremity. At this stage it is called phlegmasia cerulea dolens. The leg becomes more swollen and increasingly more painful.
While injecting a radio-dense contrast agent, an X-ray is taken. Any blood flow-limiting blockage found in the X-ray can be identified and treated by procedures including atherectomy, angioplasty, or stenting. Contrast angiography is the most readily available and widely used imaging technique.