Ultrasound examination of the veins of the lower extremities is a commonly used method to diagnose or rule out the condition of venous thrombosis. Venous ultrasound is also one of the elements of the process of qualifying a patient for surgery to remove varicose veins. During the examination, the doctor may recognize other changes that cause swelling of the calves or skin changes on the legs, e.g. lymphoedema of the subcutaneous tissue or traumatic hematoma. Ultrasound examination of the veins of the lower extremities requires experience and proficiency in assessing the anatomical variability of the venous vessels observed in different people.
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Indications for the ultrasound of venous vessels
The ultrasound of the veins of the lower extremities is usually performed in the following situations:
suspected or necessary to rule out venous thrombosis,
looking for the cause of limb swelling, calf ulcers or chronic pain and a feeling of heaviness in the legs,
preparation for the surgery of varicose veins.
Symptoms of acute venous thrombosis are:
warmth and swelling of the limb,
reddening of the skin,
widening of the superficial veins,
pain in the foot and / or calf that increases with pressure.
Suspected acute venous thrombosis is a serious emergency and requires immediate medical consultation.
Preparation for ultrasound of the veins
The examination requires uncovering the lower limbs from the feet to the groin area. If the ultrasound of the veins is performed again, bring your previous test results with you.
Preparation for ultrasound of the veins
The examination requires uncovering the lower limbs from the feet to the groin area. If the ultrasound of the veins is performed again, bring your previous test results with you.
What does the ultrasound of the veins of the lower extremities look like?
Ultrasound examination includes the assessment of deep and superficial veins along the entire length of the lower limb from the foot to the groin. Sometimes it is also necessary to evaluate the iliac veins in the pelvis and the inferior vena cava in the abdominal cavity. Venous vessels are tested at their full length every 1 cm. During the examination, the patient is lying down, standing or sitting with legs lowered - the body position depends on the currently examined section of the venous vessels and the general condition of the patient. The doctor covers the skin of the examined person's legs with a special gel and then places the ultrasound head on it. The image obtained thanks to the reflection of ultrasonic waves from the tissues is observed on the monitor screen.
What does the doctor assess during the examination?
Basic examination of the vascular bed includes grayscale ultrasound combined with color Doppler imaging and spectral recording (PW Doppler). Each vessel is assessed in the transverse and - if necessary - in the longitudinal view. The echogenicity of the vein lumen is assessed, which gives information about the possible presence of a thrombus or fibrosis. An ultrasound pressure test of the vessel is also performed.
The scope of ultrasound examination of the veins of the lower extremities may include:
System of deep veins
the inferior vena cava and common iliac, internal iliac and external iliac veins;
common femoral vein, deep femoral vein, femoral vein, popliteal vein,
posterior and anterior tibial veins, fibular veins, intramuscular veins.
System of superficial veins
The course and number of superficial veins and the accompanying system of deep veins are highly variable. The network of superficial veins includes:
saphenous vein (runs from the groin to the medial ankle),
connection of the saphenous vein with the femoral vein in the groin area,
external vulva, superficial epigastric vein, superficial around the hip in the groin area,
saphenous vein.
Arrangement of piercing veins
Piercing veins are vessels that connect deep veins with superficial veins.
Ultrasound pressure test
The ultrasound pressure test is used to diagnose the presence of blood clots or fibrosis in the system of deep and superficial veins. The doctor places the head centrally over the vessel, then performs pressure until the vessel lumen collapses, after releasing the pressure, moves the head 1 cm further and repeats the procedure.
Assessment of dishes using color
Color ultrasound imaging is used, inter alia, in determining the direction of blood flow, which helps to recognize reflux, i.e. the regurgitation of venous blood towards the feet.
Record of flow spectrum and measurements of reflux time
The recording of the flow spectrum serves a more precise measurement of venous reflux. During the measurement, reflux is forced backwards, e.g. by the Valsalva maneuver or peripheral massage. The doctor places the head longitudinally in relation to the course of the venous vessel.
Ultrasound examination for thrombosis
If venous thrombosis is confirmed, the doctor determines the exact location and extent of thrombotic changes in the vessels. The dimensions of the vein diameter before and after compression are recorded, which allows you to monitor the patient's condition during subsequent examinations. The age of the thrombi is also determined on the basis of their echogenicity.
Ultrasound examination before surgery for varicose veins
Before the planned surgery to remove varicose veins, it is necessary to exclude any abnormalities in the deep vein system - this allows to avoid periprocedural complications related to thrombosis. Another important goal of ultrasound is a detailed assessment of changes in the superficial vein pattern. The doctor assesses the amount of venous blood reflux and the valve capacity of the lower limb veins (saphenous, small saphenous, femoral and popliteal veins). The orifices of the main perforation veins connecting the superficial and deep veins are also described.
Source:
Małek G, Nowicki A, Standardy badań ultrasonograficznych Polskiego Towarzystwa Ultrasonograficznego – aktualizacja. Badanie żył kończyn dolnych. Journal of Ultrasonography 2014; 14: 287-296.
Frequently asked questions about ultrasound of veins:
The most common indications for venous ultrasound are persistent swelling of the lower limbs, a feeling of heaviness in the legs, pain in the calves, varicose veins. Vein ultrasound can confirm or rule out venous thrombosis. The ultrasound of the venous system is also a standard test performed before the planned surgery to remove varicose veins.
During the ultrasound examination, the patient is lying down, standing or sitting with legs lowered. The doctor covers the skin of the examined person's legs with a special gel and then places the ultrasound head on it. The image obtained thanks to the reflection of ultrasonic waves from the tissues is observed on the monitor screen. The doctor moves the probe along the course of the following veins, assessing them in very small sections (every 1 cm). Ultrasound examination includes the assessment of deep and superficial veins along the entire length of the lower limb up to the groin. Sometimes it is also necessary to examine the veins in the pelvis and abdominal cavity.
In the case of another USG examination, the results of the previously performed examinations should be brought with you - this will enable the doctor to compare the observed changes. Vein ultrasound requires exposing the lower limbs from the feet to the groin area.
