Hand-held Doppler as a screening test in primary varicose veins.

Abstract

Hand-held Doppler is in common use for evaluating varicose veins, but its accuracy in identifying the exact sites of venous reflux is inferior to that of duplex scanning. It has been suggested that duplex should be used to investigate all varicose veins, but this is currently impractical, and should be unnecessary if hand-held Doppler examination were shown to be an adequate screening test. Eighty-five patients (122 legs) with primary varicose veins were evaluated using a hand-held Doppler in the outpatient clinic, according to a protocol. Patients then had venous duplex imaging. Different methods of assessing the long saphenous vein (LSV) (tourniquet and tapping tests, and examination at and below the groin) had similar sensitivities for detecting reflux (75-86 per cent), and together detected 91 per cent of cases. Six of the nine missed had a competent saphenofemoral junction, and five had low-velocity reflux. Hand-held Doppler assessment missed 11 cases of popliteal fossa reflux; only four involved the short saphenous vein (SSV), and most had low-velocity popliteal vein reflux. Hand-held Doppler examination missed LSV or SSV incompetence in 11 per cent of legs, but these included cases with short-duration and low-velocity reflux of dubious clinical importance.