Duplex ultrasound investigation of the veins of the lower limbs after treatment for varicose veins – UIP consensus document

De Maeseneer M, Pichot O, Cavezzi A, et al. Eur J Vasc Endovasc Surg. 2011;42:89-102.

by Michel Perrin, Lyon, France

REVIEW

Duplex ultrasound is the most informative and precise investigation for assessing operative treatment outcome, knowing that physical examination is not reliable. Such assessment is crucial for various reasons. First, it checks whether the procedure report tallies with the immediate postoperative duplex ultrasound findings. Second, duplex ultrasound is the ideal noninvasive method for patient follow-up as ultrasound imaging predicts clinical recurrence.¹Third, because information provided by this investigation might improve understanding of recurrence, which can be tracked step by step in individual patients.

But to be interpreted correctly by phlebologists, duplex ultrasound findings must be standardized in terms of protocol procedure and terminology.  Recommendations on both are clearly stated in the article; furthermore the authors have rightly separated duplex ultrasound examination after open surgery and endovenous ablation (thermal and chemical). Supporters of CHIVA (ambulatory conservative hemodynamic management of varicose veins and ASVAL (Ambulatory Selective Varicose vein Ablation under Local anesthesia) will probably be a little bit disappointed as duplex ultrasound postoperative assessment and follow-up of these procedures preserving the saphenous trunk are not mentioned.^2,3

One issue is clearly underlined: unfortunately we still do not have a clear idea of the relationship between the clinical, etiological, anatomical, pathophysiological (CEAP) classification of chronic venous disorders, Venous Clinical Severity Score, and other generic and quality of life assessments with duplex ultrasound. Consequently, the present document should not be used alone, but with similar existing or newly produced consensus documents on clinical reporting. It should be remembered that duplex ultrasound assessment does not matter to the patient, who evaluates operative treatment outcome in terms of cosmetic results and symptoms.

The bibliography is exhaustive, with 94 references in total, but it is unfortunate that editorial policy does not allow highlighting of key papers and major review articles, which would be helpful for the reader.

In conclusion, this outstanding consensus article provides valuable guidance for duplex ultrasound assessment of patients after any kind of operative treatment.

References:
1. De Maeseneer MG, Vandenbroeck CP, Hendriks JM, Lauwers PR, Van Schil PE. Accuracy of duplex evaluation one year after varicose vein surgery to predict recurrence at the saphenofemoral junction after five years. Eur J Vasc Endovasc Surg. 2005;29:308-312.
2. Cappelli M, Molino Lova R, et al. Comparison between the CHIVA cure and stripping in the treatment of varicose veins of the legs: follow-up of 3 years J Mal Vasc. 1996;21:40-46
3. Pittaluga P, Chastanet S, Rea B, Barbe R. Midterm results of the surgical treatment of varices by phlebectomy with conservation of a refluxing saphenous vein. J Vasc Surg. 2009;50:107-118.