VENOUS INCOMPETENCE (Varicose vein) ULTRASOUND - Pathology
Venous Incompetence (VI) and Chronic Venous Insufficiency (CVI) are interchangable terms.
FLOW DYNAMICS
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NORMAL FLOW In the normal cicumstance, the superficial system drains the subcutaneous tissues and periodically empties into the deep system via perforating veins.
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| Normal venous flow and valve movement, |
 Click image to enlarge. |
INCOMPETENT FLOW 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).
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| Incompetent valve & perforator leading to venous reflux. |
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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.
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| 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
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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)
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Click to enlarge |
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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
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| 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.
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| A prominant Incompetent perforating vein. |
A small Incompetent perforating vein. |
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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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