Venous Diagnostic Tools

Abstract Duplex ultrasound (DU) is the gold standard for the diagnosis of infrainguinal venous disease; although DU is a misnomer since three modalities are used in the examination—greyscale, color flow, and pulsed wave Doppler. Image optimization is critical and is explained in detail herein. Venous duplex imaging of the retroperitoneal iliac veins and vena cava has been slow to be adopted into everyday use; however, current ultrasound technology allows for more depth of penetration with improved image resolution. Plethysmography and venography have their limitations. Cross sectional imaging (CT/MR) is expensive and operator dependent. The gold standard to determine the threshold for iliocaval stenting relies on intravascular ultrasound (IVUS) for measuring the perimeter of the venous wall using planimetry.