Venous Incompetence (VI) and Chronic Venous Insufficiency (CVI) are interchangable terms.



 Animation of normal venous flow and valve movement.


In the normal cicumstance, the superficial system drains the subcutaneous tissues and periodically empties into the deep system via perforating veins.

Flow direction should always be:

  1. Cephalad.
  2. Superficial to deep.
Normal venous flow and valve movement,


 Animation of INCOMPETENT venous flow and valve movement.Click image to enlarge.


With distal augmentation, flow initially goes cephalad. It then refluxes back down the leg through the malfunctioning valve.

An incompetent perforating vein also allows blood to flow from the deep veins to the surface veins.

This combination of back pressure causes dilation and tortuosity of the veins (ie varicosites).


Incompetent valve & perforator leading to venous reflux.


 Ultrasound of an open venous valve and a closed valve.

Normal venous valve.

Mouse over to see open / closed leaflets

The rigid posterior valve leaflet and flailing anterior lvalve leaflet are visible on B mode ultrasound.


A video clip of a normal vein valve (LS)
A video clip of a normal vein valve (TS)


Deep venous Incompetence

Commonly, secondary to a prior history of Deep vein Thrombosis (DVT). Post Thrombotic Syndrome

 Doppler showing a competent vein.  Doppler showing an incompetent vein.

A normal, competent Femoral Vein.

Flow ceases during valsalva.

Incompetent Femoral Vein:

Retrograde flow throughout valsava with return of normal flow when valsalva is relaxed.


Incompetent Saphen-Femoral Junction (SFJ)


 Ultrasound of incompetent SFJ

Click to enlarge

 Sapheno-femoral incompetence

Click to enlarge

SFJ Augmented:

Retrograde flow occurs following the distal augmentation (i.e.calf or popliteal squeeze).

SFJ Valsalva:

Retrograde flow will persist throughtout the Valsalva. (See flow bounded by red arrows)


Superficial Vein incompetence

This is where the majority of the scan is performed, assessing:

  • Great (Long) Saphenous vein (GSV)
  • Short Saphenous Vein (SSV)
  • Varices
  • Perforating veins
 Doppler ultrasound of an incompetent GSV  Ultrasound of an incompetent varix.
During distal augmentation, normal direction flow is increased (spike) followed immediately by turbulent retrograde flow.
An Incompetent varix. rtrograde flow during valsalva, and return of normal flow after relaxing.


Incompetent Perforating Veins

  • Flow should always be superficial to deep (competent). If flow is observed deep to superficial, the vein is incompetent.
  • Any incompetent perforating veins (IPVs) or competent perforators >3mm should be noted in the report.

 Incompetent Perforating vein


 Samll but incompetent perforating vein

Click to enlarge

A prominant Incompetent perforating vein.
A small Incompetent perforating vein.


 A large incompetent Perforating vein

Click to enlarge

 Ultrasound spectral doppler of an incompetent perforating vein

Click to enlarge

A large incompetent perforating vein. Use pulsed doppler with augmentation to confirm incompetence. Note the sustained retrograde flow following augmentation (red and above the line).




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