Venous Symptoms and Signs and the Results of Duplex Ultrasound: Do They Agree?

Venous disease of the legs is common and comprises a wide spectrum of clinical severity from asymptomatic incompetence through hyphen-web, reticular and trunk varices to the skin changes of chronic venous insufficiency (CVI) and chronic venous ulceration (CVU) [1]. In the UK, more than 50 000 varicose vein (VV) operations are performed each year [2] and the direct annual health care costs of treating leg ulceration are estimated at £400–600 million [3]. In most developed countries venous disease accounts for 1-2% of total direct health care spending [4–6]. The indirect financial costs of venous disease are unknown but are almost certainly several-fold higher. It is perhaps surprising, therefore, how little information is available in the literature concerning the relationships between: (1) the presence of “venous” symptoms and objective evidence of venous disease on clinical examination (signs); (2) clinical status (symptoms and signs) and the results of venous investigations aimed at defining, functionally and anatomically, the pattern and severity of the venous disease; and (3) surgical intervention and improvements in clinical status and the results of such investigations.