Evaluation of the venous system by Doppler ultrasound and photoplethysmography or light reflection rheography before sclerotherapy.

Transmission of high pressure, from deep to superficial venous system of the leg, often causes varicosis of superficial veins. High-pressure transmission frequently occurs through reverse flow or leakage through malfunctioning valves. Therefore, the goal of varicose or telangiectatic vein treatment to stop the leak or reflux at its origin by eliminating vein segments with faulty valves. Noninvasive diagnostic tests such as Doppler ultrasound allow reflux sites to be identified and targeted before treatment. Doppler ultrasound permits assessment of competence of the sapheno-femoral junctions and lesser saphenous-popliteal vein junctions bilaterally and detection of points of reflux through suspected incompetent perforating veins in the thigh, calf, and ankle. Photoplethysmography (PPG), or light reflection rheography (LRR), offers a simple, reproducible technique for physiologic evaluation of the effectiveness of the calf muscle pump and quantification of the degree of venous insufficiency as well as differentiation between superficial and deep venous insufficiency. A combination of Doppler ultrasound and PPG/LRR readily identifies those patients who may derive a medical benefit from treatment of a physiologically abnormal venous system. The presence of reflux by Doppler is indicative of a venous problem that is more than cosmetic. Treatment may consist of sclerotherapy alone or a combination of surgical ligation of an incompetent sapheno-femoral junction followed by sclerotherapy.